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阵发性交感神经过度兴奋对重症卒中患者预后的影响
宋璐王泳李海东刘洁
()
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目的 回顾性分析阵发性交感神经过度兴奋(PSH)对重症卒中患者的意识水平、功能预 后以及并发症的影响。方法 收集 2018 年 1 月至 2019 年 1 月由外院神经重症监护室转入首都医科大学 附属复兴医院康复中心行康复治疗的重症卒中患者 36 例,比较合并 PSH 组(11 例)及非 PSH 组(25 例)之 间入院时和出院时的基线信息,比较两组修订版昏迷恢复量表评分(CRS-R)、功能独立性评分(FIM)和 格拉斯哥预后评分(GOS),以及住院期间并发症的发生率。结果 PSH 组患者更年轻[(43.60±7.21)岁 比(63.25±16.13)岁,P=0.023]。两组之间在入院时和出院时 CRS-R 评分、FIM 评分和 GOS 评分差异无 统计学意义(P> 0.05)。并发症方面,脑积水、胃肠道疾病和健侧张力异常升高发生率在两组之间差异 有统计学意义,在 PSH 组发生率更高(分别为 6/11 比 12.00%,P=0.021;8/11 比 20.00%,P=0.034;5/11 比 4.00%,P=0.006)。结论 本研究发现 PSH 发作对重症卒中患者的意识水平和功能预后没有明显负性影 响,合并 PSH 的重症卒中患者更容易出现脑积水、消化道疾病及健侧的异常张力升高。但本研究样本 量较小,混杂因素偏多,还需进一步扩大样本量进行随访观察。
基金项目:
Effect of paroxysmal sympathetic hyperactivity on the prognosis of severe stroke
Song Lu, Wang Yong, Li Haidong, Liu Jie
()
Abstract:
Objective To retrospectively analyze the effects of paroxysmal sympathetic hyperactivity (PSH)on the level of consciousness, functional prognosis and complications of patients with severe stroke. Methods Patients with severe stroke transferred from the neurological intensive care unit (NICU) to our department for rehabilitation from January 2018 to January 2019 were selected. The baseline information, coma recovery scale-revised (CRS-R), functional independence measure (FIM) and Glasgow outcome scale (GOS) were compared at admission and at discharge, and the incidence of complications during hospitalization were compared between the PSH group (n=11) and the non-PSH group(n=25). Results Patients with PSH were younger [(43.60±7.21) vs. (63.25±16.13), P=0.023]. There was no significant difference between the PSH group and the non-PSH group in CRS-R, FIM and GOS score at admission and at discharge (P< 0.05). There were significant differences in the incidence of hydrocephalus, gastrointestinal tract disease and hypertonia at the unaffected side, which were all higher in the PSH group (6/11 vs.12.00%,P=0.021;8/11 vs. 20.00%, P=0.034;5/11 vs. 4.00%, P=0.006, respectively). Conclusions PSH did not show any obvious negative effect on the arousal level and functional outcomes in patients with severe stroke. Severe stroke patients with PSH are more likely to have hydrocephalus, gastrointestinal diseases, and hypertonia on the unaffected side. However, given the small sample size of this study, it is necessary to expand the sample size for further observation.

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