急性腦傷患者功能恢復之初探

Investigation of functional recovery in acute brain damaged patients - A pilot study

岳采潔(Tsai-Chieh Yueh)

指導教授 ： 王靜怡

中山醫學大學/醫學科技學院/物理治療學系/碩士(2019年)

https://doi.org/10.6834/CSMU201900133

摘要

背景與目的:腦傷經常造成患者長期失能，嚴重影響生活品質。若能瞭解與功能恢復的相關因子，將有助於醫療人員規劃合適的醫療照護計畫及出院後照顧之安排。過去研究主要在復健科病房進行，本碩士論文針對發病後的急性住院階段進行研究，包括兩個子題: (一)老年腦傷患者急性住院時的姿勢控制能力(The Postural Assessment Scale for Stroke Patients，PASS)與住院時功能、出院時功能、及住院期間功能改變量之關係；(二)中風類型與性別對於中風後六個月內日常生活(activities of daily living，ADL)恢復的影響及其預測因子。方法: 2017/9/1起至2019/1/3，在某醫學中心急性病房物理治療室，徵詢符合收案條件之急性腦傷患者。結果: (一)腦傷急性住院的老年患者，入院時的PASS與入院及出院功能的相關；住院期間PASS改變量也與功能改變量相關。(二)梗塞型中風ADL顯著進步發生在中風後3個月內，出血型中風則在6個月內逐次進步。結論: (一)老年腦傷患者，急性住院時的PASS與功能狀態相關。(二)急性住院時的ADL可以預測梗塞型和出血型中風後第3個月的ADL，僅能預測梗塞型6個月的ADL表現。

關鍵字

腦傷 ； 日常生活活動 ； 中風患者姿勢評估量表

並列摘要

Background and purpose: Brain damaged surviors often suffered from long term disability and that seriously affects their quality of life. Knowing the functional recovery related factors would help appropriate medical care planning and discharge arrangement. Related literatures were often done in inpatient rehabilitation units. In this thesis, we investigate two questions on brain damaged patients during their acute hospitalization: (1) was the admitted postural control ability (The Postural Assessment Scale for Stroke Patients, PASS) related to functional score at admission, discharge, and amount of change during the hospitalization on brain-damaged patients at least 65 years old; (2) the influence of stroke types and sex on ADL recovery in six months after stroke and its predictors. Methods: From 2017-09-01 to 2019-01-03, we recruited acute brain-damaged patients who met the study criteria in a physiotherapy room of an acute ward in a medical center. Results: (1) the admitted PASS was related to the admitted and discharged functional scores; the PASS change was also related to the functional change during hospitalization. (2) Infarcted stroke survivors showed significant functional recovery within the first 3 months whereas the hemorrhaged stroke patients continued to improve during the first 6 months. Cnclusion: (1) The PASS scores are related to functional status for older brain-damaged patients. (2) Admitted ADL predictes ADL at 3-month in both CI and ICH but only predict ADL at 6-month in CI.

並列關鍵字

brain damaged ； activities of daily living ； The Postural Assessment Scale for Stroke Patient

參考文獻

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases, 40(5), 373-383.

Alexander, M. P. (1994). Stroke rehabilitation outcome. A potential use of predictive variables to establish levels of care. Stroke, 25(1), 128-134.

Almenkerk, S. v., Smalbrugge, M., Depla, M. F., Eefsting, J. A., Hertogh, C. M. (2013). What predicts a poor outcome in older stroke survivors? A systematic review of the literature. Disability and rehabilitation, 35(21), 1774-1782.

Ang, Y. H., Chan, D. K., Shen, Q., & Heng, D. M. (2003). Patient outcomes and length of stay in a stroke unit offering both acute and rehabilitation services. Medical Journal of Australia,178(7), 333-336.

Benaim, C., Pérennou, D. A., Villy, J., Rousseaux, M., & Pelissier, J. Y. (1999). Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke, 30(9), 1862-1868.