缺血缺氧性脑病91例康复治疗临床分析

Analysis on rehabilitation care of 91 cases of hypoxic-ischemic encephalopathy

目的探讨成人缺血缺氧性脑病的病因、功能障碍特点及康复治疗效果和预后相关因素。方法回顾性分析2012年8月至2016年12月中国康复研究中心北京博爱医院神经康复科收治的91例缺血缺氧性脑病患者的临床资料,总结患者病因、功能障碍表现,比较综合康复治疗前后功能障碍的改善情况。结果病因:一氧化碳中毒21例,突发呼吸心跳骤停13例,手术中发生13例,呼吸循环衰竭9例,窒息8例,脑血管意外8例,脑外伤6例,电击伤4例,中毒3例,过敏性休克3例,高血糖酮症酸中毒昏迷1例,羊水栓塞1例,热射病1例。其中实施心肺复苏58例(63.7%),气管插管21例(23.1%),气管切开29例(31.9%)。功能障碍中,合并症状性癫痫21例(23.1%),认知功能障碍81例(89.0%);运动功能障碍患者75例(82.4%):单纯锥体束损伤42例(46.2%),单纯锥体外系损伤11例(12.1%),共存22例(24.2%)。康复治疗前的简易精神状态检查(MMSE)评分为13.09±10.87,康复治疗后的评分为16.21±11.13,差异有统计学意义(t=3.741,P=0.001)。康复治疗前日常生活活动能力(ADL)评分为13.09±10.87,康复治疗后为16.21±11.13,差异有统计学意义(t=5.287,P<0.001)。康复治疗前步行能力评分为1.36±1.76,治疗后为1.66±1.83,差异有统计学意义(t=3.466,P=0.001)。康复治疗前平衡障碍评分为5.30±4.97,治疗后为6.26±4.96,差异有统计学意义(t=-5.91,P<0.01)。结论缺血缺氧性脑病患者往往出现皮层、锥体系统、锥体外系统、小脑系统损害,表现为认知、运动、构音障碍,情绪障碍。经综合康复治疗后,患者的认知功能、步行能力、平衡功能、日常生活能力均可得到改善。

Objective To explore the etiologies, characteristics of functional disorders, effects of rehabilitation care and prognostic factors of adult hypoxic-ischemic encephalopathy. Methods Retrospective analysis was performed for clinical data of 91 patients with hypoxic-ischemic encephalopathy admitted to Department of Neurological Rehabilitation, Beijing Charity Hospital of China Rehabilitation Research Center, from August 2012 to December 2016.Thc etiologies and manifestations of functional disorders were summarized; the characteristics of injuries and the improvement in functional disorders as the result of rehabilitation care were analyzed by comparison. Results The etiologies were carbon monoxide poisoning in 21 patients, sudden respiratory and cardiac arrest in 13 patients, surgical accidents in 13 patients, respiratory circulatory failure in 9 patients, asphyxia in 8 patients, cerebrovascular accidents in 8 patients, brain trauma in 6 patients, electric injury in 4 patients, intoxication in 3 patients, allergic shock in 3 patients, hyperglycemic keto-acidic coma in 1 patient, amniotic fluid embolism in 1 patient, and heat stroke in 1 patient. Among the patients, 58 （63.7%） received emergency CPR, 21 （23.1%） received tracheal intubation, and 29 （31.9%） received tracheal incision. The complicated functional disorders were symptomatic epilepsy in 21 （23.1%） patients, cognitive dysfunction in 81 （89.0%）; motor dysfunction in 75 （82.4%） patients; simple pyramidal tract injury in 42 （46.2%） patients, simple extrapyramidal system injury in 11 （12.1%） patients, and both pyramidal tract and extrapyramidal system injuries in 22 patients （24.2%）. The mini-mental state examination （MMSE） score was 13.09±10.87 and 16.21±11.13 before rehabilitation and after rehabilitation, there was significant difference （t=3.741, P=0.001）. The activities of daily living （ADL） score was 13.09±10.87 and 16.21±11.13 before rehabilitation and after rehabilitation, there was significant difference （t=-5.287, P〈0.001）. The ambulation score was 1.36±1.76 and 1.66±1.83 before rehabilitation and after rehabilitation, there was significant difference （t=-3.466, P=0.001）. The balance disturbance score was 5.30±4.97 and 6.26±4.96 before rehabilitation and after rehabilitation, there was significant difference （t= -5.91, P〈0.01）. Conclusion Patients with hypoxic-ischemic encephalopathy typically present injuries of cortex, pyramidal system, extrapyramidal system, and cerebellar system, with the manifestations of cognitive and motor dysfunctions, dysarthria, and emotional disorder. Comprehensive rehabilitation care could improve the patient＇s cognitive function, ambulation, balance function, and ADL.