动脉瘤性蛛网膜下腔出血后综合康复195例临床分析  

Clinical analysis of 195 cases of comprehensive rehabilitation after aneurysmal subarachnoid hemorrhage

作　　者：郭鸣[1,2] 李冰洁[1,2] 赵军[1,2] 梅利平[1,2] GUO Ming;LI Bingjie;ZHAO Jun;MEI Liping(China Rehabilitation Research Center,Beijing 100068,China;Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China)

机构地区：[1]中国康复研究中心,北京100068 [2]首都医科大学康复医学院,北京100068

出　　处：《中国实用神经疾病杂志》2022年第9期1097-1102,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家重点研发计划(编号:2020YFC2008500,2020YFC2008502);北京科技计划(编号:Z201100005520082)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血患者的综合康复治疗效果,了解不同部位动脉瘤对患者功能障碍的影响。方法回顾性分析2011-10—2021-10中国康复研究中心收治的195例动脉瘤性蛛网膜下腔出血患者的一般资料、手术方法、量表评分、主要功能障碍。结果经过康复治疗,患者简易精神状态检查量表评分(t=—8.239,P<0.001)、Fugl-Meyer评定量表运动评分(t=—7.360,P<0.001)和Fugl-Meyer平衡评分(t=—10.096,P<0.001)、ADL明显改善(t=—12.392,P<0.001),NIHSS评分下降(t=8.257,P<0.001)。不同位置动脉瘤手术方法选择不同,前交通动脉瘤、颈内动脉瘤行介入栓塞术较高分别达56.2%、73.3%,差异有统计学意义(χ^(2)=4.844,P=0.028;χ^(2)=5.229,P=0.022),大脑中动脉瘤行夹闭术组更高,达77.8%,差异有统计学意义(χ^(2)=16.167,P<0.001)。动脉瘤的位置对于运动功能障碍单双侧(χ^(2)=20.819,P=0.004)、锥体外系功能障碍(χ^(2)=16.190,P=0.001)、动眼神经损伤(χ^(2)=12.384,P=0.004)的影响有统计学差异。结论综合康复治疗能改善动脉瘤性蛛网膜下腔出血患者的认知功能、运动功能、平衡功能以及日常生活能力。大脑中动脉瘤选择夹闭术者更多。前交通动脉瘤导致双侧肢体运动障碍的比例明显增高,前交通动脉瘤、大脑前动脉瘤破裂更容易造成锥体外系运动功能障碍,后交通动脉瘤则更易造成动眼神经损伤。不同障碍患者需要进行个体化康复治疗。Objective To investigate the effect of comprehensive rehabilitation treatment of patients with aneurysmal subarachnoid hemorrhage,and to understand the effects of different parts of aneurysms on patients’dysfunction.Methods The general data,surgical methods,scale scores and main dysfunction of 195 patients with aneurysmal subarachnoid hemorrhage in the China Rehabilitation Research Center from October 2011 to October 2021 were analyzed retrospectively.Results After rehabilitation treatment,the patients’mini-mental state exami⁃nation(t=-8.239,P<0.001),Fugl-Meyer motor score(t=-7.360,P<0.001),Fugl-Meyer balance score(t=-10.096,P<0.001),ADL improved significantly(t=-12.392,P<0.001),and NIHSS score decreased(t=8.257,P<0.001).The choice of surgical methods for aneurysms at different locations is different.Interventional embolization for ante⁃rior communicating artery aneurysms and internal carotid artery aneurysms is higher,up to 56.2%and 73.3%respectively,and the dif⁃ference is statistically significant(χ^(2)=4.844,P=0.028;χ^(2)=5.229,P=0.022),and the middle cerebral artery aneurysm clipping group was higher,up to 77.8%,the difference was statistically significant(χ^(2)=16.167,P<0.001)The location of aneurysms had different ef⁃fects on the unilateral and bilateral motor dysfunction(χ^(2)=20.819,P=0.004),extravertebral dysfunction(χ^(2)=16.190,P=0.001)and oc⁃ulomotor paralysis(χ^(2)=12.384,P=0.004).Conclusion Comprehensive rehabilitation therapy can improve the cognitive function,mo⁃tor function,balance function and daily living ability of patients with aneurysmal subarachnoid hemorrhage.More middle cerebral ar⁃tery aneurysms were selected for clipping.The proportion of bilateral limb dyskinesia caused by anterior communicating aneurysms is significantly increased.The rupture of anterior communicating aneurysms and anterior cerebral aneurysms is more likely to cause ex⁃travertebral motor dysfunction,while posterior communicating aneurysms are more likely to cause oculomotor nerve injury.Patie

关 键 词：动脉瘤性蛛网膜下腔出血 康复 功能障碍 前交通动脉瘤 大脑中动脉瘤 大脑前动脉瘤 后交通动脉瘤 

分 类 号：R743.35[医药卫生—神经病学与精神病学]