脑卒中Pusher综合征的临床研究

Clinical study of pusher syndrome in stroke patients

目的 研究一定区域内脑卒中偏瘫患者Pusher综合征的发生比例及其与脑损伤侧及神经心理学症状的相关性 ,探讨Pusher综合征的发生机制和相关对策。方法 实验组Pusher综合征 39例 ,对照组91例。检查脑损伤部位及相关神经心理学症状 ,每周施Barthel指数 (BI)评价及功能训练、ADL训练等。结果在本区域内 ,Pusher综合征占研究阶段所有入院康复脑卒中患者的 1 7% ,占入选患者的 30 %。右脑损伤Pusher综合征发生比例高于对照组 (P <0 .0 0 1 )。实验组单侧空间忽略和疾病失认的发生比例高于对照组(P <0 .0 0 1 )。实验组脑出血患者Pusher综合征的发生比例多于脑梗死 (P <0 .0 1 ) ,额、颞、顶叶及基底节及内囊后肢均受损的百分率 ,实验组明显高于对照组 (P <0 .0 1 )。两组治疗后的BI指数均明显高于治疗前(P <0 .0 0 0 1 )。两组间最后的ADL水平的百分率差异无显著性 (P >0 .0 5)。在获得同一水平最佳功能所需时间上 ,实验组比对照组多 9周 (P <0 .0 5)。结论 Pusher综合征在本研究阶段、一定区域内 ,占所有入院康复治疗脑卒中患者的 1 7% ,占偏瘫不能行走患者的 30 %。而且多在右脑损伤时出现 ,易伴有神经心理学症状。Pusher综合征不影响患者最后的功能恢复 。

Objective To investigate the incidence of the pusher syndrome in stroke patients, and the relationship between the syndrome and the neuropsychological symptoms and location of brain lesion, and to investigate the mechanism and the physiotherapy intervention of pusher syndrome. Methods Thirty nine patients(25 male, 14 female, 62.5±9.4 years old) with pusher syndrome were examined, 91 patients(57 male,34 female, 58.4±11.6 years old) without ipsilateral pushing served as control. The lesion areas, neuropsychological syndrome and the Barthel Index(BI) were recorded, and the physiotherapy were administered in the patients. Results The incidence of pusher syndrome was 30% in the patients studied, corresponding to 17% of the total number of stroke patients in the study period. The percentage of pusher syndrome occurrence was higher in the patients with right side lesion than those with left side lesion ( P <0.001), those with hemorrhage than with infarction ( P <0.001) The percentage of space neglect and apraxia patients was significantly higher in those with pusher syndrome than the controls ( P < 0.01 ). The scores of the BI on ADL function at discharge was significantly higher than the BI on admission in both groups ( P <0.001). The length of stay of the patients with pusher syndrome was 9 weeks longer than the controls ( P <0.05) . Conclusion The incidence of pusher syndrome was 17% among all hospitalized stroke patients and 30% among the hemiplegic patients in this study. Pusher syndrome more likely occur in those with the right hemisphere lesion and neuropsychological symptoms. The pusher syndrome did not affect the functional outcome, but lengthened hospital stay of the patients.