51例芦山地震颅脑损伤伤员早期康复效果分析
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摘要
目的收集四川大学华西医院"4.20"芦山地震震后2周颅脑损伤伤员的临床资料,对其临床特征和早期康复治疗的疗效进行分析,为应急医学救援中颅脑损伤伤员的早期康复治疗提供基线数据。方法对2013年4月20日～5月3日四川大学华西医院收治的392例芦山地震伤员进行筛查,由脑外伤康复治疗前移组对其中的颅脑损伤伤员进行床旁评估和早期康复治疗,比较治疗前后日常生活活动能力(ADL)和Rancho Los Amigos(RLA)认知功能分级情况。采用Excel软件录入数据,并使用SPSS软件进行统计分析。结果共纳入51例颅脑损伤伤员,年龄范围3～84岁。颅脑损伤类型包括:蛛网膜下腔出血(41.2%)、颅内血肿(33.3%)和混合型(33.3%),其严重程度与颅脑损伤类型相关。脑震荡GCS评分较高(13.25±0.62),弥漫性轴索损伤GCS评分较低(4.50±0.71)。100%伤员出现日常生活能力受限,74.51%伤员出现认知知觉功能障碍,9.80%伤员出现言语障碍,还有7.84%伤员出现吞咽障碍。经早期康复治疗后,伤员的ADL评分(治疗前34.82±20.58分,治疗后69.63±22.29分)和RLA认知知觉功能分级(治疗前4.16±1.24,治疗后7.20±1.69)较治疗前明显提高,且差异均有统计学意义(P<0.05)。结论芦山地震颅脑损伤伤员的脑损伤类型多样,且常合并存在,其严重程度与颅脑损伤类型相关。所有伤员常伴多种临床问题和功能受限。早期康复治疗安全有效,可迅速改善伤员认知功能和日常生活活动能力。
Objective To collect the clinical data of victims with traumatic brain injury(TBI) admitted in the West China Hospital of Sichuan University within 2 weeks after 4.20 Lushan earthquake,and to analyze their clinical characteristics and effects of early rehabilitation,so as to provide baseline data for rescue TBI victims with the early rehabilitation treatment during emergency medical rescue.MethodsA total of 392 victims admitted in the hospital from April 20th,2013 to May 3rd,2013 were screened,of which the TBI victims were clinically assessed and treated with early rehabilitation.Then both the activities of daily living(ADL) and the Rancho Los Amigos Cognitive Recovery Scale(RLA) before and after the treatment were analyzed.The data were input by Excel software,and the statistical analysis was performed by SPSS softwar.ResultsA total of 51 TBI victims at age from 3 to 84 years old were included finally.The categories of TBI included subarachnoid hemorrhage(41.2%),intracranial hematoma(33.3%) and mixed type(33.3%),and the severity were associated with the type of TBI.The GCS score of cerebral concussion was higher(13.25 ± 0.62) while that of the diffuse axonal injury was lower(4.50 ± 0.71).All victims(100%) had limited ADL,74.51% had cognitive dysfunction,9.80% had speech disorder,and 7.84% had dysphagia.After the early rehabilitation treatment,both ADL(before treatment: 34.82 ± 58.29,after treatment: 69.63 ± 22.29) and RLA(pre-treatment: 4.16 ± 1.24,treatment: 7.20 ± 1.69) were obviously higher than those before treatment,with statistical differences(both P <0.05).ConclusionThe TBI categories of Lushan earthquake victims are various and mixed,and the severity associated with the type of TBI.All TBI victims are accompanied with more clinical problems and functional limitation.Early rehabilitation treatment is safe and effective to improve ADL and RLA as well.
Objective To collect the clinical data of victims with traumatic brain injury(TBI) admitted in the West China Hospital of Sichuan University within 2 weeks after 4.20 Lushan earthquake,and to analyze their clinical characteristics and effects of early rehabilitation,so as to provide baseline data for rescue TBI victims with the early rehabilitation treatment during emergency medical rescue.MethodsA total of 392 victims admitted in the hospital from April 20th,2013 to May 3rd,2013 were screened,of which the TBI victims were clinically assessed and treated with early rehabilitation.Then both the activities of daily living(ADL) and the Rancho Los Amigos Cognitive Recovery Scale(RLA) before and after the treatment were analyzed.The data were input by Excel software,and the statistical analysis was performed by SPSS softwar.ResultsA total of 51 TBI victims at age from 3 to 84 years old were included finally.The categories of TBI included subarachnoid hemorrhage(41.2%),intracranial hematoma(33.3%) and mixed type(33.3%),and the severity were associated with the type of TBI.The GCS score of cerebral concussion was higher(13.25 ± 0.62) while that of the diffuse axonal injury was lower(4.50 ± 0.71).All victims(100%) had limited ADL,74.51% had cognitive dysfunction,9.80% had speech disorder,and 7.84% had dysphagia.After the early rehabilitation treatment,both ADL(before treatment: 34.82 ± 58.29,after treatment: 69.63 ± 22.29) and RLA(pre-treatment: 4.16 ± 1.24,treatment: 7.20 ± 1.69) were obviously higher than those before treatment,with statistical differences(both P <0.05).ConclusionThe TBI categories of Lushan earthquake victims are various and mixed,and the severity associated with the type of TBI.All TBI victims are accompanied with more clinical problems and functional limitation.Early rehabilitation treatment is safe and effective to improve ADL and RLA as well.
引文
1刘宏亮,吴宗耀.汶川地震伤员康复医疗的成就与思考.中华物理医学与康复杂志,2008,30(12):794-795.
2何成奇.地震伤员康复治疗指南.四川医学,2008,29:17-23.
3余秀君,何成奇,丁明甫.华西医院地震伤员康复医疗的应急体系.中国康复医学杂志,2008,23(7):585-586.
4赵继宗.主编.临床诊疗指南-神经外科学分册.第1版,北京:人民卫生出版社,2007:15-49.
5 Ralph M.Buschbacher.Rehabilitation a er TBI.Physical Medicine&Rehabilitation,2007:1091-1278
6罗庆禄,周宗科,沈彬,等.汶川大地震骨折伤员日常生活活动能力受限的临床研究.华西医学,2009,3(24):529-531.
2何成奇.地震伤员康复治疗指南.四川医学,2008,29:17-23.
3余秀君,何成奇,丁明甫.华西医院地震伤员康复医疗的应急体系.中国康复医学杂志,2008,23(7):585-586.
4赵继宗.主编.临床诊疗指南-神经外科学分册.第1版,北京:人民卫生出版社,2007:15-49.
5 Ralph M.Buschbacher.Rehabilitation a er TBI.Physical Medicine&Rehabilitation,2007:1091-1278
6罗庆禄,周宗科,沈彬,等.汶川大地震骨折伤员日常生活活动能力受限的临床研究.华西医学,2009,3(24):529-531.
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