儿童创伤性颅脑损伤康复治疗相关因素及预后分析  

Factors predicting rehabilitation outcomes for children with traumatic brain injury

作　　者：杨华[1] 高勇[1] 周定富[1] 范海玲[1] 尤玉慧[1] 陈翔[1] 

机构地区：[1]温州医学院附属第二医院暨育英儿童医院康复医学科,温州325027

出　　处：《中华物理医学与康复杂志》2012年第7期511-515,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的了解和分析创伤性颅脑损伤（TBI）患儿的康复治疗概况及其预后情况，以探讨合理的康复评定及其治疗措施。方法回顾性分析温州医学院附属第二医院康复医学科2006年1月至2011年5月首次入院行康复治疗的64例TBI患儿的一般临床情况及其康复治疗情况、意识状态、日常生活活动（ADL）能力恢复情况、总体康复疗效及其影响因素等。结果①住院康复治疗的TBI患儿颅脑损伤以重型颅脑损伤为主（66％），意识障碍者占42．19％，肢体运动障碍型患儿以偏瘫为主（51．67％），主要（65．63％）在伤后1个月内行康复干预；平均住院13为（33．09±25．96）d，意识障碍者住院时间比无意识障碍者长（P〈0．05）；治疗措施以高压氧、运动疗法和营养神经药物为主（分别占95．31％、89．06％和82．81％）；②经首次住院康复治疗后患儿苏醒率达81．48％，ADL有显著改善（P〈0．01），总有效率达90．63％；③单因素和多因素分析均显示，年龄小和康复介入时间迟是影响近期康复效果的2个不良因素。结论综合康复治疗可有效改善创伤性颅脑损伤患儿意识状态，促进运动功能恢复，提高生活自理能力，受伤年龄越大，康复介入时间越早，近期康复结局越好。Objective To investigate the rehabilitation prognoses of children with traumatic brain injury （TBI）. Methods A retrospective analysis was made in 64 children who had been admitted for rehabilitation. Their clinical information, rehabilitation protocols, recovery of consciousness and ability in the activities of daily living （ADL） were analyzed. Results The children＇s injuries were severe-42. 19% had consciousness disorders, but 80% of them recovered consciousness after rehabilitation. Their limb motor dysfunction was dominated by hemiplegia （51.67%）. For 65.63% of the patients rehabilitation was initiated within one month after injury. The average length of stay in rehabilitation was 33.09 ± 25.96 days. Those with consciousness disorders stayed significantly longer than those without. The main treatments were hyperbaric oxygen therapy, exercise and neurotrophie drugs （the ratios were 95.31% , 89.06%0 and 82.81% respectively）. After the first course of inpatient rehabilitation, the consciousness recovery rate was 81.48% and ADL ability improved significantly. The total effectiveness rate was 90.63% . Univariate and multivariate analyses showed that the factors most strongly correlated with effective rehabilitation were age at injury and the rehabilitation intervention time. Conclusion The results suggest that a general hospital should focus on early （ acute and subacute phase） rehabilitation. So developing the rehabilitation network system is necessary and urgent. Rehabilitative therapy is very helpful in TBI cases. Being older at the time of injury and earlier rehabilitation intervention predict better short term outcomes. It is necessary to build and improve on a more standardized and systemic rehabilitation and assessment system for pediatric TBI.

关 键 词：创伤性颅脑损伤 儿童 康复 相关因素 康复结局 

分 类 号：R726.5[医药卫生—儿科]