成人自发性基底节区脑出血患者日常生活活动能力的影响因素

Factors Affecting Activities of Daily Living in Patients with Spontaneous Basal Ganglia Hemorrhage

目的探讨未行手术治疗的成人首发基底节区脑出血患者日常生活活动能力的影响因素,以期早期制定干预措施,提高患者日常生活活动能力。方法采用前瞻性队列研究连续收集成人首发基底节区脑出血未行手术治疗且存活的患者97例。入院当天记录人口基线资料,进行卒中危险因素调查,行美国国立卫生研究所脑卒中评分(national institute of health stroke scale,NIHSS)和格拉斯哥昏迷评分(GCS);入院次日清晨行白细胞计数、空腹血糖等多项实验室指标的测定;发病3周行NIHSS评分及Barthel指数(Barthel index,BI)评分;出院时记录住院期间肺部感染、尿路感染的发生情况;发病3个月时通过门诊或电话随访BI评分。结果脑出血患者发病3周及3个月时BI评分的影响因素为出血量、入院首次空腹血糖、白细胞计数及首次NIHSS评分,发病3个月时影响因素还包括既往缺血性卒中病史、住院期间并发尿路感染。结论早期采取措施控制影响因素,有利于提高脑出血患者日常生活活动能力及工作能力。

Objective To investigate the factors affecting activities of daily life （ADL） in pa- tients with first basal ganglia hemorrhage, and to formulate intervention strategies for improving the capability of ADL. Methods A prospective study was conducted on 97 patients with the first spontaneous intracerebral hemorrhage who survived with no surgical treatment. Demographic risk factors for stroke were examined and National Institute of Health stroke scale （NIHSS） and Glasgow coma score （GCS） were recorded on the day of admission. White blood cell（WBC） count and plasma glucose （PG） were measured on the second day of hospitalization. NIHSS score and Barthel index （BI） were recorded 3 weeks after onset. Occurrences of urinary tract and lung in- fection were determined after discharge from hospital. BI was recorded by clinic or telephone fol- low-up 3 months after onset. Results The amount of bleeding,initial PG levels,WBC count and initial NIHSS score were independently associated with BI at 3 weeks and 3 months after sponta-neous intracerebral hemorrhage. Furthermore, urinary tract infection and the history of ischemic stroke were associated with BI at 3 months after intracerebral hemorrhage. Conclusion Positive measures should be taken to control risk factors so as to improve the capability of ADL in patients with spontaneous intracerebral hemorrhage.