CAJ | 학술논문

目的根据早期脑卒中患者不同的发病部位和性质,研究患者的血管性认知功能损害(VCI)特点,以便在临床采取相应的认知康复治疗而提高疗效.方法通过前瞻性病例对照研究,用洛文斯顿作业疗法认知评定成套测验(LOTCA)对符合人选标准的119例早期脑卒中患者在入院1周内进行认知功能评定,比较不同发病性质的大脑左、右侧半球损伤患者的VCI特点.结果左大脑半球梗死组与出血组比较,LOTCA总分差异无统计学意义;但梗死组知觉分组总分高于出血组(P<0.05).右大脑半球梗死组和出血组比较,LOTCA总分和分项总分差异均无统计学意义(P>0.05).比较左、右大脑半球脑梗死组,LOTCA总分左侧低于右侧(P<0.05),其中定向、思维运作分组总分左侧低于右侧(P<0.01或<0.05);比较左、有大脑半球脑出血组,LOTCA总分差异无统计学意义,但定向、知觉分组项左侧低于右侧(P<0.01或0.05).结论左大脑出血和梗死者相比,出血者更要注重知觉功能的康复;左和右侧大脑梗死者相比,左大脑梗死者更要注重对定向、思维运作训练;左和右侧大脑出血者相比,左大脑出血者更要注重对定向、知觉功能训练.
목적 근거조기뇌졸중환자불동적발병부위화성질,연구환자적혈관성인지공능손해(VCI)특점,이편재림상채취상응적인지강복치료이제고료효.방법 통과전첨성병례대조연구,용락문사돈작업요법인지평정성투측험(LOTCA)대부합인선표준적119례조기뇌졸중환자재입원1주내진행인지공능평정,비교불동발병성질적대뇌좌、우측반구손상환자적VCI특점.결과 좌대뇌반구경사조여출혈조비교,LOTCA총분차이무통계학의의;단경사조지각분조총분고우출혈조(P<0.05).우대뇌반구경사조화출혈조비교,LOTCA총분화분항총분차이균무통계학의의(P>0.05).비교좌、우대뇌반구뇌경사조,LOTCA총분좌측저우우측(P<0.05),기중정향、사유운작분조총분좌측저우우측(P<0.01혹<0.05);비교좌、유대뇌반구뇌출혈조,LOTCA총분차이무통계학의의,단정향、지각분조항좌측저우우측(P<0.01혹0.05).결론 좌대뇌출혈화경사자상비,출혈자경요주중지각공능적강복;좌화우측대뇌경사자상비,좌대뇌경사자경요주중대정향、사유운작훈련;좌화우측대뇌출혈자상비,좌대뇌출혈자경요주중대정향、지각공능훈련.
Objective To characterize the vascular cognitive impairment of stroke patients with different injury sites (right or left cerebral hemisphere) and pathological type (hemorrhage or infarct). Methods A total of 119 stroke patients were assessed with regard to their cognitive functions using the LOTCA within one week of admis-sion, and comparison was made among patients in terms of VCI characteristics, injury site, and pathological type. Results In patients with left hemisphere injury, there found no significant difference between those with cerebral in-farct and hemorrhage with regard to the total score of LOTCA, but the score of perception of those with hemorrhage was lower than those with infarct(P<0.05). in patients with right hemisphere injury, both total score of LOTCA and the subscore were not significantly different between those with infarct and hemorrhage(P>0.05). In patients with infarct in left hemisphere, the total score of LOTCA was lower than those with infarct in right hemisphere(P<0.05), but the scores of orientation and thinking operation were lower than those with infarct in right hemisphere(P<0.001 or <0.01). In patients with hemorrhage in the left hemisphere, the total score of LOTCA was not significantly different from those with hemorrhage in right hemisphere, but the scores of orientation and perception were lower than thosewith hemorrhage in right hemisphere(P<0.001 or <0.01). Conclusions More attention with regard to perception training should be paid to those with cerebral hemmorhage than those with cerebral infarct. In patients with cerebral infarct, more attention with regard to orientation and thinking operation training should be paid to those with infarct in left side, while for those with cerebral hemorrhage, more attention with regard to orientation and perception training should be paid to the left hemisphere insult.