- 學位論文
自發性腦出血患者復健後之生活獨立功能改善的預測因子
Predictive Factors for the Functional Independence Improvement in Patients with Spontaneous Intracerebral Hemorrhage after Rehabilitation
摘要
研究目的：自發性腦出血（spontaneous intracerebral hemorrhage, ICH）對病人的生活功能上有很大的影響。腦出血評分（ICH score）是一種簡單的臨床分級量表，提供腦出血病人三十天內死亡率的預測結果。我們將納入了腦出血評分和其他可能影響功能恢復的因子，去找出可以預測自發性腦出血病人接受復健之後，在功能獨立量表（Functional Independence Measure, FIM）進步的預測因子。 研究方法及資料：本實驗是回溯性世代研究。收入了從2011年1月至2020年12月之間所有發生自發性腦出血的病患，病人在病情穩定後馬上於復健科接受復健，我們分析病人的各種基本特徵和功能獨立量表改善幅度的關係。 研究結果：所有836位自發性腦出血的病患於住院中的總死亡率為15%（ICH score 0 到6分的死亡率分別為2%、4%、10%、34%、52%、57%和25%）。存活和死亡的病人去做比較，有顯著的差異的因子為APACHE II、ICH score、腦出血的體積、格拉斯哥昏迷指數、睜眼反應、語言反應、運動反應、住院天數、天幕下出血，腦是內出血和凝血功能異常(p<0.05)。其中309個病人有接受復健和功能獨立量表的評估，取中位數來當作分界，把病人分成兩組比較(分成≦6為進步較差和>6為進步較多的兩組)，有顯著意義的為：APACHE II、ICH score、腦出血的體積、格拉斯哥昏迷指數、睜眼反應、語言反應和運動反應，多變項迴歸分析顯示最重要的因子為ICH score。在運動功能變化方面，分成≦5和>5的兩組，有顯著意義的為：年齡、APACHE II、ICH score、腦出血的體積、格拉斯哥昏迷指數、睜眼反應、語言反應和運動反應，多變項迴歸分析顯示最重要的因子為ICH score和年齡。而認知功能的變化，分成≦0和>0為兩組，有顯著意義的只有住院天數和手術，迴歸分析後則都沒有顯著意義。 結論與建議： ICH score、 APACHE II、腦出血的體積、格拉斯哥昏迷指數、睜眼反應和語言反應可以當作預測因子，用來預估病人接受復健後是否有更好的功能獨立量表分數的進步，預測因子中最重要的則是ICH score，其中FIM主要進步的貢獻，主要來自於運動功能的改善，而認知功能改善幅度有限。
並列摘要
Objective：Spontaneous intracerebral hemorrhage (ICH) has a great impact on the life function of patients. The ICH score is a simple clinical grading scale that provides predictive value on the mortality of patients with ICH within 30 days. We include the ICH score and other factors that may affect functional recovery to elucidate the predictive power of these factors for the patients' progress in the functional independence scale (Functional Independence Measure, FIM) after rehabilitation. Methods and Materials：This is a retrospective cohort study based on medical records. We included all patients with spontaneous ICH from January 2011 to December 2020. After the condition stabilized, the patients immediately received rehabilitation treatment in the rehabilitation department. We analyzed the relationship between various basic characteristics of patients and the extent of improvement of the FIM. Results：The overvall mortality rate of 836 patients with spontaneous ICH in hospital was 15% (the mortality rate of ICH score 0 to 6 was 2%, 4%, 10%, 34%, 52%, 57% and 25%). Comparing surviving and dead patients, there are significant differences in the factors except age, gender and surgery (p<0.05). Among them, 309 patients were evaluated by the Rehabilitation and FIM score, and the patients were divided into two groups by the median of FIM score (≦6 for poor progress and >6 for more progress). The progress of FIM is significantly related to APACHE II, ICH score, volume of ICH, Glasgow coma score, eye opening response, verbal response and motor response. Multivariate regression analysis shows that the most important factor is ICH score. The changes in motor function are divided into two groups(≦5 and >5). The significant factors are age, APACHE II, ICH score, volume of ICH, Glasgow coma score, eye opening response, verbal response and motor response. Multivariate regression analysis shows that the most important factors are ICH score and age. The changes in cognitive function are divided into two groups(≦0 and >0). The only significant factors are the length of hospitalization and surgery, but after regression analysis, there is no significant meaning Conclusion and Suggestion：ICH score, APACHE II, ICH volume, Glasgow coma score, eye opening response and verbal response can be used to predict whether the patient will have a better improvement in the score of FIM after receiving rehabilitation. The most important predictor is ICH score. The progress of FIM mainly comes from the improvement of motor function rather than cognitive function.