目的 探讨脑干卒中吞咽障碍患者的临床特征、康复治疗效果及影响因素.方法 回顾性分析2018年4月至2021年12月北京博爱医院收治的脑干卒中后吞咽障碍的患者.收集患者性别、年龄、病程、治疗时间等一般资料,吞咽造影咽期结果,治疗前后才藤荣一吞咽障碍7级评价法(DSS)评分、Fugl-Meyer评定量表(FMA)评分、FMA-平衡功能评分、美国国立卫生研究院卒中量表中文版(NIHSS)评分、Barthel指数(BI)、简易精神状态检查(MMSE)评分,以及出院时是否经口进食.根据吞咽造影结果分为非环咽肌失弛缓组(对照组)和环咽肌失弛缓组(观察组).结果 共纳入患者60例,对照组29例,观察组31例.观察组FMA评分、FMA-平衡功能评分、BI、MMSE评分均明显高于对照组(|t|>3.281,P<0.01),NIHSS评分显著低于非失迟缓组(t=4.390,P<0.001).治疗前,观察组DSS评分显著低于对照组(t=5.785,P<0.001);治疗后,两组均显著提高(|t|>5.387,P<0.001);两组间比较无显著性差异(t=1.675,P=0.099),但观察组治疗前后差值明显大于对照组(t=-2.729,P=0.008).两组经口进食率无显著性差异(χ2=2.742,P=0.098).对照组内,经口进食与鼻饲进食患者间,FMA-平衡功能评分、NIHSS评分、BI指数、入院时吞咽障碍严重程度评分有显著性差异(|t|>2.429,P<0.05);观察组内,经口进食与鼻饲进食患者间,各因素无显著性差异(P>0.05).对照组内入院时DSS评分为能否经口进食的影响因素(OR=3.947,95％CI 1.361～11.450,P=0.012),观察组内无独立影响因素.结论 脑干卒中导致吞咽障碍患者中,出现环咽肌失弛缓患者吞咽障碍程度重,伴随障碍轻.脑干卒中吞咽障碍患者康复治疗有效,环咽肌失弛缓患者治疗效果总体好于非环咽肌失弛缓患者.非环咽肌失弛缓患者吞咽障碍预后与入院时吞咽障碍严重程度相关,环咽肌失弛缓患者预后与各临床因素无关.

目的 探讨脑卒中后Holmes震颤的发生率以及综合治疗的效果.方法 回顾性调查2019年10月至2021年9月本院神经康复病房脑卒中患者中诊断Holmes震颤的患者,收集其临床信息、影像学表现、药物治疗方案、康复评定量表评分、康复方案和治疗效果.结果 共收治脑卒中恢复期患者715例,其中Holmes震颤5例,发病率0.7％,均为脑出血患者,占脑出血恢复期患者1.7％.患者均为男性,中脑和脑桥出血3例,小脑出血1例,丘脑出血1例.震颤发病在出血后1.5～7个月,均表现为头部伴肢体震颤,同时并发其他神经功能障碍.治疗后,4例震颤好转,1例无效.患者Fugl-Meyer评定量表运动和平衡评分无明显改善(P>0.05),日常生活活动能力评分有所提高(P<0.05).结论 Holmes震颤在脑卒中患者中发生率较低.经综合治疗后,震颤大部分有所改善,但对运动功能效果不佳.

目的:探讨中西医结合疗法对遗传性痉挛性截瘫的临床效果.方法:将15例遗传性痉挛性截瘫患者分为西医治疗组(西医组,n=5)及中西医结合治疗组(联合组,n=10).西医组采取手术、术后康复训练及口服药物巴氯芬治疗,联合组在西医组的基础上联合针刺、推拿等中医疗法.干预6个月后,采用改良Ashworth(MAS)量表评估患者下肢的痉挛程度,并分别采用Berg平衡评定量表(BBS)、Holden步行功能分级评估患者的平衡能力及步行功能,然后采用改良Barthel指数(MBI)评估患者的日常生活能力.结果:治疗后,联合组患者左下肢、右下肢MAS分级均低于治疗前及西医组(P<0.05),但联合组患者的BBS评分、Holden分级和MBI评分均高于治疗前及西医组(P<0.05).结论:在西医治疗的基础上联合中医针刺、推拿治疗,有利于缓解遗传性痉挛性截瘫患者下肢的痉挛程度,改善其平衡能力及步行能力,提高生活质量.

目的 观察旋律音调疗法对脑卒中后非流畅性失语的临床康复疗效以及脑功能改变.方法 2017年3月至2019年8月,选取本院脑卒中后非流畅性失语患者40例,随机分为对照组和音乐组各20例,两组均接受言语治疗,音乐组在此基础上接受以旋律音调疗法为主的音乐治疗.治疗前和治疗4周后,采用中国康复研究中心汉语标准失语症检查表(CRRCAE)评定其听理解、复述、阅读、命名.两组各选3例患者,治疗前后行静息态fMRI,比较大脑半球局部一致性(ReHo).结果 治疗后,对照组听理解(名词、动词、句子)、复述(名词、动词)、阅读(名词)和命名(动作说明)评分提高(t>2.221,P<0.05),音乐组听理解(名词、动词、句子)、复述(名词、动词、句子)、阅读(名词、动词)和命名(名词、动作说明)评分提高(t>2.179,P<0.05).治疗前后差值比较,音乐组复述(名词、动词)评分增加更多(t>2.299,P<0.05),阅读(句子)评分有增加的趋势.治疗后,患者静息状态下左侧小脑、颞枕区的ReHo增强,双侧额叶、颞叶皮质ReHo降低.结论 在言语训练基础上,联合旋律音调疗法可进一步改善脑卒中后非流畅性失语患者的言语功能,特别在句子阅读和单词复述方面.ReHo改变可能与脑损伤后神经修复有关.

目的 探讨缺血缺氧性脑病恢复期患者综合康复治疗的效果.方法 回顾性分析2014年1月至2016年12月收治28例缺血缺氧性脑病恢复期患者的一般资料、康复评定方法和主要问题点、康复治疗手段及功能评分.结果 经康复治疗,患者简易精神状态检查评分、Fugl-Meyer评定量表运动评分和平衡评分、Holden步行分级以及改良Barthel指数分级改善(Z>2.588,P<0.05).结论 综合康复治疗能改善缺血缺氧性脑病恢复期患者认知功能、运动功能、步行和日常生活活动能力.

Objective To investigate the clinical and rehabilitation treatment of hypertrophic olivary degeneration(HOD)secondary to brainstem hemorrhage.Methods The clinical data of one patient with HOD secondary to pontine hemorrhage was retrospectively analyzed. In addition to the disability of the primary disease,involuntary jitter of the right limb gradually presented and aggravated.The patient re-ceived physical therapy,occupational therapy,acupuncture,hydrotherapy and medication.Results After one and a half-month rehabilitation and treatment,the patient improved from standing unsteadily and unable to walk to standing and walking independently.The score of Berg Balance Scale improved from 28 to 38,and the score of modified Barthel Index improved from 70 to 80.The involuntary jitter of the right limb was relieved.Conclusion The symptoms and disabilities of HOD secondary to pontine hemorrhage can be relieved by medication and rehabilitation,and the activities of daily living can be improved.

1病历摘要 患者男性，41岁，主因“左侧肢体活动不利5月余”以“脑出血恢复期”收入院。5月余前活动时无明显诱因突发左侧肢体活动不利，上肢不能持物，不能保持坐位，无明显头痛、呕吐及肢体抽搐，伴有二便失禁。送至当地医院，测血压200/140mmHg。头CT检查示右侧基底节区脑出血，出血量约120ml，行去骨瓣减压及血肿清除术。术后3~4d意识转清，能够认识家人，无明显自发言语，左侧肢体活动不能，2个月后，患者病情逐渐稳定，床旁肢体被动活动及针灸等康复训练治疗。但患者一直呈嗜睡状态，唤醒后可回答简单问题，左侧肢体不能活动。病后曾数次出现突发四肢抽搐，双眼上翻，口吐白沫，呼之不应，考虑为癫痫发作，给予丙戊酸钠抗癫痫治疗。目前患者仍呈轻度嗜睡状态，左侧肢体活动不能，坐位平衡不能维持，日常生活大部分依赖他人帮助，既往高血压病史10余年，最高200/140mmHg，平素未规律监测及口服药物控制，有睡眠呼吸暂停病史。

Objective:To observe spasticity influence on neural function and ability of daily living in stroke patients. Method:To retrospectively observe,from March 2013 to June 2014,584 inpatients in our department,and evaluate respectively,in the course of 1 month,3 months and 6 months,spasticity MAS assessment,NIHSS assessment,and Barthel for ADL in patients with spastic muscle tension and neural function and ability of daily living. Result:At the course of 1 month,3 months and 6 months,result of NIHSS assessment and Barthel between spasticity and without spasticity patients,moderate and severe spasticity patients showed that there was significant difference(P<0.05). Conclusion:Spasticity in stroke patients with 1 month,3 months and 6 months have a negative impact on neural function and ability of daily living,more severe spasticity,neural function and ability of daily living is poor.

Objective To investigate the stapled trans-anal rectal resection(STARR) and Altemeir's resection for rectum prolapse in spinal cord injury(SCI) patients.Methods Anus bowel disease of 260 SCI patients were investigated,21 cases with rectum prolapse who were invalid for nonoperative treatment chose Altemeir's resection or STARR depending on the degree of rectum prolapse.They were recorded according to International Spinal Cord Injury Bowel Function Based and Extension Set before and 12 months after operation.Results 85 SCI patients were with rectum prolapse(32.7%),21 patients complicated with constipation and mixed hemorrhoid,19 with rectal mucous membrane prolapse(7 cm),4 with rectal internal mucous intussusception,2 were completely rectum prolapse(7 cm).Rectum prolapse of Ⅰ degree was found in 13 cases,Ⅱ in 5 cases,and Ⅲ in 3 cases.Patients with Ⅰ or Ⅱ degrees rectum prolapse accepted STARR,those with Ⅲ degrees accepted Altemeir's resection.No serious complication was found.Self-report of intestinal dysfunction affecting the quality of life during the 12 months after operation significantly decreased(P0.01),so as the need of drawing out defecate with hands(P0.01),the usage of liner,plug,or antidiarrheal(P0.001).The symptom such as endless defecate feeling,abdominal distension,abdominal pain,abdominal discomfort were significantly alleviated(P0.05).Conclusion STARR and Altemeir's resection are both safe and effective operation for rectum prolapse in SCI patients.

Objective To explore the percutaneous endoscopic gastrostomy on patients with central nervous system injuries in neurological rehabilitation and to establish enteral nutrition.Methods Thirty-two patients with central nervous system were enrolled for percutaneous gastrostomy,using the Pull technique.Results The successful rate of percutaneous gastrostomy as Pull technique was 100%,2 cases of stomach bleeding through endoscopy. Straining the fixation gasket and partial compression stoped bleeding. One patient appeared swelling and secretions in abdominal incisions,and recovered after dealing with local iodophor and changing fresh dressing. Hypostatic pneumonia occurred in one patient,and improved after anti-infective treatment. No serious complications occurred.Conclusion Percutaneous gastrostomy is a simple and safe for the patients with central nervous system injuries.

Objective To summarize the application of percutaneous endoscopic gastrostomy(PEG) in 25 patients with cerebral apoplexy and consciousness obstacle for rehabilitation.Methods Under intravenous anesthesia and ECG monitoring,25 patients with cerebral apoplexy and consciousness obstacle at rehabilitation received PEG,the perioperative management was strengthened,especially on the observation and treatment of lung infection.Results The successful rate of PGE was 100%,operating time was(10±3) min on average;No operative death,bleeding,abdominal associated complications occurred,such as the abdomen inflammation,both preoperative and perioperative.Although 2 cases had cardiopulmonary complications reoccurred,after prompt treatment the symptoms were improved immediately.Patients were further followed up from 6 to 18 months,and postoperative lung infection was controlled effectively.Conclusion PEG is a safe operation for patients with cerebral apoplexy and consciousness obstacle at rehabilitation,which can help to control lung infection,but the strengthening of perioperative management is still needed.

开塞露广泛应用于便秘的治疗,但是不正确掌握适应证和用法,会引起一系列不当后果,如直肠肛管损伤和溃疡。

目的总结脊髓损伤患者急腹症的诊断及处理经验,提高治疗水平.方法对2000年至今的10例脊髓损伤急腹症住院患者的临床资料进行回顾性分析.结果 10例患者中,9例治愈,1例死亡.结论重视脊髓损伤患者急腹症的诊断和处理,有利于及时治疗.