早期高压氧联合康复训练对行微创钻孔置管引流术后高血压脑出血患者的康复效果影响  

Effect of early hyperbaric oxygen combined with rehabilitation training on the rehabilitation effect of patients with hypertensive cerebral hemorrhage after minimally invasive drilling and drainage

作　　者：李程 陈丽娟[1] Li Cheng;Chen Lijuan(Department of Rehabilitation Medicine,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,Zhejiang,China)

机构地区：[1]浙江大学医学院附属第一医院康复医学科,浙江杭州310003

出　　处：《加速康复外科杂志》2022年第2期55-61,共7页JOURNAL OF ENHANCED RECOVERY AFTER SURGERY

摘　　要：目的:探讨早期高压氧(hyperbaric oxygen,HBO)联合康复训练对行微创钻孔置管引流术后的高血压脑出血(hypertensive intracerebral hemorrhage,HICH)患者康复效果的影响。方法:将2019年3月至2021年3月于浙江大学医学院附属第一医院行微创钻孔置管引流术的110例HICH患者随机分为对照组和HBO组,每组55例。对照组患者于术后生命体征平稳且病情趋于稳定48h后进行康复训练,HBO组患者在对照组治疗基础上加以早期HBO治疗(待患者病情稳定后进行)。比较两组患者治疗前后脑血管血流动力学[平均血流速度(Vm)、平均血流量(Qm)、动态阻力(DR)、外周阻力(Rv)]、神经与认知功能[美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分及简易精神状态量表(mini-mental state examination,MMSE)评分]、运动及生活能力[Fugl-Meyer运动功能量表(Fugl-Meyer Motor Function Scale,FMA)]评分及日常生活活动能力量表(activities of daily living,ADL)评分]等方面情况,记录两组患者治疗术后10 d的血肿基本清除率和住院天数,观察组两组患者在术后再出血发生率、脑脊液漏发生率和颅内感染率,并随访3个月采用格拉斯哥预后评分(Glasgow outcome score,GOS)评价患者预后。结果:治疗前两组患者年龄、性别、高血压病程等一般资料、脑血管血流动力学、神经与认知功能、运动及生活能力等方面比较差异无统计学意义(P>0.05);治疗后,HBO组脑血肿体积显著小于对照组(P<0.05),Vm及Qm均显著高于对照组(均P<0.05),DR与Rv均显著低于对照组(均P<0.05),NIHSS评分显著低于对照组(P<0.05),平均住院天数显著短于对照组(P<0.05),MMSE评分、FMA评分及ADL评分均显著高于对照组(均P<0.05)。HBO组与对照组治疗术后10 d的血肿清除率(85.45%比70.91%)、术后再出血发生率(1.81%比3.62%)、脑室穿刺点脑脊液漏发生率(3.62%比18.18%)、颅内感染发生率(3.62%比18.18%)以及预Objective:To explore the effect of early hyperbaric oxygen(HBO)combined with rehabilitation training on the recovery of patients with hypertensive intracerebral hemorrhage(HICH)after minimally invasive drilling and catheter drainage.Method:A total of 110 patients with HICH who underwent minimally invasive burr hole drainage in the First Affiliated Hospital,Zhejiang University School of Medicine from March 2019 to March 2021 were randomly divided into the control group and HBO group,55 cases in each group.Patients in the control group underwent rehabilitation training 48 hours after the postoperative vital signs were stable and the condition tended to be stable,patients in the HBO group received early HBO treatment on the basis of the treatment in the control group(after the patients'condition was stable).The cerebral vascular hemodynamic indexes[average blood velocity(Vm),average blood flow(Qm),dynamic resistance(DR),peripheral resistance(Rv)],neurological and cognitive function[National Institutes of Health Stroke Scale(NIHSS)score and mini-mental state examination(MMSE)score],exercise and living ability[Fugl-Meyer Motor Function Scale(FMA)]score and[activities of daily living(ADL)score],the 10-day basic hematoma clearance rate and the length of hospital stay were recorded,The bleeding rate,cerebrospinal fluid leakage rate and intracranial infection rate of patients in the two groups,patients were followed up for 3 months by Glasgow outcome score(GOS).Result:Before the treatment,there was no significant difference in age,gender,course of hypertension and other general information,cerebrovascular hemodynamics,neurological and cognitive function,exercise and living ability between the two groups(P>0.05).After the treatment,the volume of cerebral hematoma in HBO group was significantly smaller than that in the control group(P<0.05),Vm and Qm were significantly higher than those in the control group(all P<0.05),DR and Rv were significantly lower than those in the control group(all P<0.05).The NIHSS scores were signi

关 键 词：早期高压氧 康复训练 钻孔置管引流术 高血压脑出血 术后康复 

分 类 号：R493[医药卫生—康复医学]