摘要：

目的 探讨基底节区出血血肿穿刺置管引流术（简称引流术）后早期康复治疗的有效性和安全性。方法 共 80 例行引流术的基底节区出血患者随机分为两组，每组 40 例，早期康复组在引流术后 2 天、对照组在引流术后 7 天均予为期 2 周的康复治疗；在康复治疗前、治疗 2 周和 3 个月随访时评定患肢 Fugl-Meyer 运动功能（FMA）、Barthel 指数（BI），以及 3 个月随访时进行改良 Rankin 量表（mRS）预后评估，同时统计两组患者的肺部感染、下肢静脉血栓和再出血发生率。结果 两组患者康复治疗2周和3 个月随访时 FMA 评分（t = -16.288，P = 0.000；t = -45.638，P = 0.000）和 BI 评分（t = -20.188，P = 0.000；t = -48.938，P = 0.000）高于治疗前，3 个月随访时 FMA 评分（t = -29.350，P = 0.000）和 BI 评分（t = -28.750，P = 0.000）高于治疗 2 周时；早期康复组各观察时间点 FMA 评分（F = 7.505，P = 0.008）和 BI 评分（F = 7.029，P = 0.010）均高于对照组。3 个月随访时早期康复组患者预后优于对照组（Z = -3.591，P = 0.000），肺部感染发生率低于对照组［45%（18/40）对 67.50%（27/40）；χ² = 4.114，P = 0.043］。结论 基底节区出血引流术后早期进行康复治疗可以有效提高患者运动功能和日常生活活动能力，并降低肺部感染发生率，同时不增加再出血风险。

关键词: 脑出血, 基底神经节, 引流术, 康复

Abstract:

Objective To observe the efficiency and safety of early rehabilitation for patients with basal ganglia hemorrhage after hematoma puncture and catheter drainage. Methods A total of 80 basal ganglia hemorrhage patients treated with hematoma puncture and catheter drainage were randomly divided into 2 groups: control group (N = 40) received a two-week rehabilitation program 7 d after operation and early rehabilitation group (N = 40) received a two-week rehabilitation program 2 d after operation. They were assessed by Fugl-Meyer Assessment Scale (FMA), Barthel Index (BI) before and after 2-week treatment, as well as 3 months after treatment (during the following-up period), and they were also assessed by modified Rankin Scale (mRS) 3 months after 2-week treatment. The incidence of pulmonary infection, lower extremity venous thrombosis and rebleeding in 2 groups were statistically analyzed. Results Compared with before treatment, FMA score (t = -16.288, P = 0.000; t = -45.638, P = 0.000) and BI score (t = -20.188, P = 0.000; t = - 48.938, P = 0.000) of patients in both groups were all significantly increased after 2-week treatment and 3 months after treatment. Besides, FMA score (t = -29.350, P = 0.000) and BI score (t = -28.750, P = 0.000) of patients in both groups 3 months after treatment were higher than those after 2-week treatment. Compared with control group, FMA score (F = 7.505, P = 0.008) and BI score (F = 7.029, P = 0.010) were significantly increased in early rehabilitation group. Compared with control group, the prognosis in early rehabilitation group was better (Z = -3.591, P = 0.000). The incidence of pulmonary infection in early rehabilitation group were lower than that in control group [45% (18/40) vs. 67.50% (27/ 40); χ²= 4.114, P = 0.043]. Conclusions Early rehabilitation contributes to better motor recovery and ability in the activities of daily living for basal ganglia hemorrhage patients treated with hematoma puncture and catheter drainage. Early rehabilitation can reduce the incidence of pulmonary infection without increasing the risk of rebleeding.

Key words: Cerebral hemorrhage, Basal ganglia, Drainage, Rehabilitation