慢性脑积水患者的早期发现及康复治疗的临床研究

Clinical research on the discovery of chronic hydrocephalus as soon as early and rehabilitative therapy

目的:探讨脑外伤后慢性脑积水对患者康复效果的影响。总结早期诊断慢性脑积水的方法及手术治疗后患者的临床康复效果。方法:根据临床表现、体格检查、康复功能评价和影像学资料(除外其它导致脑室扩大疾病),28例患者被诊断为慢性脑积水并及时给予脑室腹腔分流术治疗。术后积极开展肢体功能、语言、认知、心理、情感等神经康复治疗,强调预防性和主动性为主的康复治疗原则。结果:22例昏迷患者中,12例逐渐清醒,2例呈低反应状态,另外的6例非昏迷患者的功能障碍均有明显改善。昏迷患者的GCS评分治疗前为(4.50±1.16)分,治疗半年后为(14.16±0.83)分,两者比较差异有显著性意义(P<0.05)。28例患者标准Barthel指数评分治疗前为(22.66±2.15)分,治疗半年后为(65.88±10.24)分,两者比较差异有显著性意义(P<0.05)。损伤6个月内的患者康复效果较好,而损伤6个月以上的患者预后差。结论:康复科医生是否能够早期发现慢性脑积水,及时实施脑室腹腔分流术,并开展以预防性、主动性为主的全面的康复治疗是决定患者预后的重要因素。

Objective: To study the affection of chronic hydrocephalus after brain injury on patients′ rehabilitation and to summary the methods of diagnose chronic hydrocephalus during rehabilitation and the result after operation and rehabilitative therapy. Method: According to the clinical examination, assessment of rehabilitation, and imaging data (except for other diseases which could cause ventricle large),28 brain injury patients were diagnosed as chronic hydrocephalus and received ventriculoperitoneal shunt(PVS).The neural rehabilitation treatments were used after PVS, and the rehabilitative principle of prevention and active training were emphasized. Result: Twelve of 22 coma patients recovered gradually,two patients became minimal responsive and another 6 clear-headed patients′ function improved greatly. The GCS score before treatment was(4.50±1.16), and the one after treatment was (14.16±0.83), so there was significant difference between them(P<0.05). The standard Barthel score was significantly higher before treatment(22.66±2.15)than that of after treatment.(65.88±10.24)(P<0.05).The time when patients got chronic hydrocephalus was very important-less than 6 months, patients had good rehabilitative results; More than 6 months, patients had bad results.Conclusion:It is very important that physiatrists find chronic hydrocephalus as soon as possible and make patients have VPS operation, besides preventive and active rehabilitation treatment are the necessary factors which decide patients′ prognosis.