关于Pusher现象的症状学研究

A study on symptom of Pusher phenomenon

目的：探讨脑中风时Ｐｕｓｈｅｒ现象的症状发生规律。方法：调查中枢性瘫痪患者的病灶、运动功能及半侧空间忽略等，将出现Ｐｕｓｈｅｒ现象的患者分为二组，一组采用作者提出的整体性训练方法，另一组采用常规训练方法。结果：脑中风Ｐｕｓｈｅｒ现象发生率为２３％，其中左侧瘫占６２．５％，右侧瘫占３７．５％。Ｐｕｓｈｅｒ现象的责任病灶多与两个以上脑叶受损有关，其中均包括颞叶。Ｐｕｓｈｅｒ现象有７５％在发病１个月内出现。采用不同训练方法的二组Ｒｉｖｅｒｍｅａｄ运动指数有显著差异。Ｐｕｓｈｅｒ现象伴有单侧空间忽略症的发生比率为５６．３％。结论：大面积脑损伤时Ｐｕｓｈｅｒ现象发生率增高，认为其产生原因与大脑整合障碍有关，半侧空间忽略症是否为独立存在的症状尚无定论。右脑损伤时出现Ｐｕｓｈｅｒ现象机会多，可能与功能定位有关。整体性训练法有助于出现Ｐｕｓｈｅｒ现象患者的康复。

Objective: To study the occurrence pattern of Pusher phenomenon at stroke and its causes.Methods:To investigate motor function,half spatial neglect symptom, etc.The patients with Pusher phenomenon were divided into two groups,one being treated with the whole training method suggested by the authors,another group with routine training method.Results: The occurrence rate of Pusher phenomenon was 23%,of which left brain paralysis accounted for 62.5%,right 37.5%.Responsible focus of Pusher phenomenon often related to the injury of more than two lobes,mostly including the temporal lobe.Seventy five percent of Pusher phenomenon occurred within one month of onset.There were significantly different Rivermead motor indexes in the two groups.Pusher phenomenon accompanied with unilateral spatial neglect symptom was 56.3% and there was no relationship between Pusher phenomenon and age,sex statistically.Conclusion: Pusher phenomenon increases when the area of brain injury increases,which suggesting that there is a relationship between the cause of Pusher phenomenon and brain dysintegration.The existance of half spatial neglect symptom may exacerbate Pusher phenomenon. It is uncertain whether the former is independent symptom. More Pusher phenomenon occurs when right brain is injuried, which may relate to functional location. The whole training method contributes to recovery of Pusher phenomenon. Author′s address\ The First Clinical College,Norman Bethune University of Medical Sciences,Changchun,Jinlin Province,130021