Goto Atsuko, Okuda Satoshi, Ito Shinji, Matsuoka Yukihiko, Ito Eiichi, Takahashi Akira, Sobue Gen
Department of Neurology at Higashi Nagoya National Hospital, Nagoya, Japan.
J Stroke Cerebrovasc Dis. 2009 Jan;18(1):60-7. doi: 10.1016/j.jstrokecerebrovasdis.2008.09.003.
This study was performed to analyze the locomotion outcome of hemiplegic patients with stroke and to explore the factors influencing it.
A total of 247 patients (mean age 65.6 +/- 10.5 years) admitted to our hospital for rehabilitation were included in the study. Their cardinal neurologic sign was hemiplegia caused by infarction in the middle cerebral artery as a result of a first stroke. When rehabilitation programs were completed, the final motor outcome was evaluated and compared between patients with right and left hemispheric infarct. In addition, the following items were analyzed: size, location, and subtype of the infarct; hemispatial neglect and aphasia; cerebral blood flow (CBF); and periventricular lucency on computed tomography scan.
(1) There was a negative relationship between the infarct size and the locomotion outcome. The difference in locomotion outcome was not significant between the patients with infarction of the perforating arteries and those of the cortical arteries. No significant difference in the locomotion outcome was found between the patients with an atherothrombotic or cardioembolic infarction. (2) In spite of the existence of hemispatial neglect or aphasia, the patients with a right-sided infarction were significantly inferior to patients with a left-sided one in locomotion outcome, except for those with a large infarction. (3) In patients with infarction in the territory of the perforating arteries, there was a negative relationship between the area of decreased CBF or periventricular lucency and the locomotion outcome. When the area of decreased CBF on the homolateral hemisphere involving the infarction extended to less than or equal to two cerebral lobes, the locomotion outcome was significantly worse in the patients with a right-sided infarction.
Overall, for the patients with middle cerebral artery infarction, the locomotion outcome was poorer in patients with a right hemispheric infarction than a left-sided one, except in the case of a large infarction.
本研究旨在分析脑卒中偏瘫患者的运动功能结局，并探讨影响其的因素。
本研究纳入了我院收治的247例康复患者（平均年龄65.6±10.5岁）。他们的主要神经系统体征为首次脑卒中导致的大脑中动脉梗死引起的偏瘫。康复项目结束后，对右侧和左侧半球梗死患者的最终运动功能结局进行评估和比较。此外，还分析了以下项目：梗死灶的大小、位置和亚型；偏侧空间忽视和失语；脑血流量（CBF）；以及计算机断层扫描上的脑室周围透亮区。
（1）梗死灶大小与运动功能结局呈负相关。穿支动脉梗死患者和皮质动脉梗死患者的运动功能结局差异无统计学意义。动脉粥样硬化血栓形成性或心源性栓塞性梗死患者的运动功能结局差异无统计学意义。（2）尽管存在偏侧空间忽视或失语，但除大面积梗死患者外，右侧梗死患者的运动功能结局明显低于左侧梗死患者。（3）在穿支动脉供血区梗死的患者中，CBF降低区域或脑室周围透亮区面积与运动功能结局呈负相关。当同侧半球累及梗死灶的CBF降低区域扩展至小于或等于两个脑叶时，右侧梗死患者的运动功能结局明显更差。
总体而言，对于大脑中动脉梗死患者，除大面积梗死外，右侧半球梗死患者的运动功能结局比左侧半球梗死患者更差。
Zotero 插件