摘要
背景:脑动静脉畸形出血对脑和肢体造成的功能损伤需要进行康复治疗以帮助其功能重建。目的:探讨康复干预对出血性脑动静脉畸形栓塞术后患者脑和肢体功能重建的效应。设计:病例分析。单位:解放军总医院介入医学科。对象:所纳入的对象为1996-01/2003-10解放军总医院治疗的经CT,MRI证实为出血性脑动静脉畸形患者共56例。方法:56例脑出血患者经数字减影血管造影证实为脑动静脉畸形,应用α-氰基丙烯酸正丁酯栓塞或结合放射外科治疗同时行康复干预治疗。康复治疗的方法:电刺激治疗采用SJ-Ⅱ型神经肌肉治疗仪刺激患肢的屈肌、伸肌,刺激强度由弱渐强,开始时每天二次,酌情渐增至每天三四次。针灸治疗选择风池、风府、印堂、上星、百会、曲池、外关、合谷、环跳、足三里、阳陵泉、三阴交、太冲等(位,合并失语者加廉泉、金津、玉液。1次/d,2周为1个疗程。肢体肌力<Ⅰ级者行患肢各关节的被动活动,肌力Ⅰ～Ⅱ级者行床边坐位及站位平衡训练,肌力>Ⅱ级者行步行训练等,活动度从小到大。伴有语言功能障碍者同时行语言功能训练。肌力评定参照Lovett的6级分级法。主要观察指标:①患者栓塞程度变化。②患者语言流利程度、肢体的感觉及肢体肌力的变化。结果:56例均纳入分析,无脱落病例。①栓塞程度变化:56例患者中43例在1～3次栓塞后病灶完全消除,占77%,7例栓塞90%,占12%,6例栓塞60%～80%,占11%。②语言流利程度变化:治疗前语言不同程度障碍者14例,治疗后语言流利程度改善者14例,其中明显改善者11例。③肢体的感觉变化:治疗前肢体感觉障碍者23例,治疗后肢体感觉均有改善,其中明显改善者18例。④肢体肌力变化:治疗前肢体肌力<Ⅰ级3例,Ⅰ～Ⅱ级11例,>Ⅱ级15例。治疗后肢体肌力0～Ⅰ级中2例恢复到Ⅱ～Ⅲ级,21例达到Ⅳ级,6例达V级。结论:经血管内
BACKGROUND： Functional injury of brain and limb induced by hemorrhage of cerebral arteriovenoas malformation could be restored by rehabilitative treatment.OBJECTIVE： To investigate the curative effect of rehabilitation on restoration of the functional injury of the brain and limbs induced by bleeding of hemorrhage cerebral arteriovenous malformation （AVM） after embolization. DESIGN： Case analysis. SETTING： Department of Interventional Medicine of General Hospital of Chinese PLA.PARTICIPANTS： From January 1996 to December 2001, a total 56 patients who were diagnosed as cerebral hemorrhage or intmventricle hemorrhage by CT or MRI scanning was selected from General Hospital of Chinese PLA. METHODS： All 56 patients with cerebral arteriovenous malformation were diagnosed by DSA. Rehabilitative treatment was performed with α-butyl eyanoac-rylate or radian surgery. Rehabilitative therapy were as follow： ① Electric stimulate： SJ-Ⅱ type nerve-muscle therapy instrument was used to stimulate the muscles （flexor and extensor） of limbs in the involved side, intensity of which is from weak to strong and frequency of which was from 2 to 3 or 4 per day; ② Acupuncture： The selected points are： Fengchi, Fengfu, Yintang, Shangxing, Baihui, Quchi, Waiguan, Hegu, Huantiao, Zusanli, Yanglingquan, Sanyinjiao, Taichong, et al. In those who suffered aphasia, lianquan, Jinjin, Yuye were selected. Once a day and a period of treatment was 2 weeks; ③ physical training： the passive movement on the joint in the involved limbs were performed in grade 0 to 1 of muscle strength, the balance training of sitting on bed or standing beside the bed in grade 1 to 2, walking training in grade 2 to 3. The training intensity should be from weak to strong gradually. The items of observation were the improvement in speaking, sense and activity in limbs in the involved side. Evaluation of myadynamia was referenced to 6 grading method of Lovett. MAIN OUTCOME MEASURES： ① the degree of embolism; ② the degree of speak
出处
《中国临床康复》
CSCD
北大核心
2005年第37期126-128,共3页
Chinese Journal of Clinical Rehabilitation
