神智清醒半癱的出血性腦中風病人使用立體定位手術及保守治療結果的比較

Outcomes of Stereotactic aspiration versus conservative treatment for clear hemiplegic patients of hemorrhagic stroke.

李文源(Wen-Yuan Lee)

指導教授 ： 藍守仁

亞洲大學/健康學院/健康管理研究所/碩士(2005年)

摘要

腦中風是國內十大死亡原因第二位，每年約有三萬五仟人發生腦中風，而30歲以上的成年人則每年每千人會有二十人罹患中風。一旦發生腦中風約有百分之三十至四十會死亡，存活下來的大部分也是殘障，而需要長期的醫療及社會照護，對病人及家庭造成沈重的經濟及精神負擔及引起社會巨大的損失。腦中風分為梗塞型及出血性腦中風，梗塞型腦中風一旦發生，就幾乎無法改變它的命運，而對於出血性腦中風的治療，雖然到目前為止仍有許多的不同的意見，但已有許多論文報告，手術移除血腫可以改善存活率及增加功能的恢復，然而這些論文最主要是針對神智昏迷，血腫較大的病人加以研究；至於神智清醒的病人，一般學者是認為不用手術的，而且也沒人加以研究，但是這些清醒而半癱的病人，雖然經過藥物及積極的復健等保守治療後，有很多依然殘廢，而需他人長期的照護。我們蒐集了從1999年到2004年神智清醒但半癱的出血性腦中風的病人，把它分成保守治療及立體定位抽吸兩組，加以研究比較，用肌力進步指數及每日生活活動力(ADL, Activity of daily living)來評估其功能恢復，其中保守治療組有五十位病人，立體定位抽吸有四十六位病人。我們發現立體定位抽組有一人因抽吸後大量的再出血而死亡，排除這個病人，立體定位抽吸組肌力進步指數，平均是5.8±2.23，ADL平均是2.09±1.33。而保守治療組肌力進步指數平均是4.48±2.49，ADL平均2.68±1.41。這兩組用t檢定加以統計比較，肌力進步指數及ADL在統計學皆有顯著差異，所以這個結果可以告訴我們，立定位抽吸術對神智清醒但半癱的出血腦中風的功能恢復是有幫助的，可是必需承擔雖然機率很小，但可能危及生命的再出血的危險性。

關鍵字

出血性腦中風、立體定位抽吸術

並列摘要

Stroke is the second leading cause of death in Taiwan, affecting 35000 people every year, and 20 in 1000 people beyond 30 years old adult. About 30 percent to 40 percent patients will be dead after stroke. Most survivors are disabled who require long-term medical and social care, imposing heavy financial and mental burdens on patients and their families and causing an enormous loss to society. There are two stroke types which are ischemic stroke ad hemorrhagic stroke. When the ischemic stroke has occurred, we rarely change its outcome. In hemorrhageic strokes, there have been many opinions in their treatment to date, but many studies report that surgical treatment may improve mortality rate and functional outcome. These papers are mainly focused on comatose patents with large intracerebal hematoma. Those patients with small intracerebral hematoma and clear consciousness are thought to be unsuitable for surgery, and who have never been studied on till now. Many of these clear but hemiplegic patients always remain disabled in spite of medical treatment and aggressive rehabilitation and require long term nursing care. In 1978, Backlund and von Holst proposed a new principle of CT-guided stereotactic aspiration of intracerebral hematomas in hemorrhagic stroke patients, several authors have used this new technique to treat comatose hemorrhagic stroke patients with large intracerebral hematomas. They reported that this new method is safe and effective for these stroke patients with the goodness of proper localization and minimal invasion of brain. According to the study results, since 1999, we started to use stereotactic aspiration to treat clear but hemiplegic hemorrhagic stroke patients. Is this method effective and safe? So we collect clear but hemiplegic hemorrhagic stroke patients from 1999 to 2004 in our hospital and divide them into two groups (conservative treatment and Stereotactic aspiration) for comparison. We use muscle power improvement scale and activity of daily living (ADL) to assess their functional outcome. There are 50 patients in conservative treatment group and 46 patients in stereotactic aspiration group. We find rebleeding after aspiration occure in one patient and leading to patient’s death. After this patient is excluded, mean of muscle power improvement scale in stereotactic aspiration group is 5.8±2.23, mean of ADL is 2.09±1.33, Mean of muscle power improvement scale in conservative treatment group is 4.48±2.49, mean of ADL is 2.68±1.41. We use t-test to analyze these two groups, these is significant difference. So this results could tell us, stereotactic aspiration may improve functional outcome in clear but hamiplegic hemorrhagic stroke patients. The method may have the chance of rebleeding, although it is small, it sometimes lead to mortality.

並列關鍵字

Hemorrhagic stroke, Stereotactic aspiration.

參考文獻

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