重症双侧延髓内侧梗死康复治疗病例报告1例并文献复习

Rehabilitation of a patient with severe bilateral medial medullary infarcts: A case report and literature review

  • 摘要:
    背景 双侧延髓内侧梗死(BMMI)又称“心形梗死”,在临床中发病率低,但由于其特殊的解剖位置导致其致残性高、死亡率高。
    目的 探讨早期、综合、全程的康复训练对重症BMMI患者的临床疗效。
    方法 对一例重症BMMI患者进行早期、全程、综合的康复训练,训练的具体内容包括:构音及吞咽训练、呼吸训练、躯干及肢体活动训练等。随访患者至发病后4个半月,并进行了卒中量表评分(NIHSS)、个人生活能力评分(改良Barthel)、神经功能恢复情况评分(MRS)以及膈肌超声评估。
    结果 该例重症BMMI患者从康复中获益很大,NIHSS评分降低了15分,改良Barthel评分提高了68分,MRS评分降低了3分。膈肌超声提示:治疗前后膈肌增厚比由20%提升至68%,膈肌移动度由21.6 mm提高到28.8 mm。截至随访日期,患者已可以独立坐位并少量辅助下站立。
    结论 早期、全程、综合的康复训练可能对重症BMMI患者的预后有积极作用。

     

    Abstract:
    Background Bilateral medial medullary infarction (BMMI), also known as “heart-shaped infarction”, has a low incidence in clinical practice, but its special anatomical location leads to high disability and mortality.
    Objective To explore the clinical efficacy of early, comprehensive, and full-course rehabilitation training for patients with severe BMMI.
    Methods Early, comprehensive and full-course rehabilitation training was carried out for a patient with severe BMMI, including phonation and swallowing training, respiratory training, trunk and limb movement training, etc. The patient’s follow-up time was four months. The National Institute of Health Stroke Scale (NIHSS), Activity of Daily Living Scale (Modified Barthel), Modified Rankin Score (MRS), and diaphragmatic ultrasound evaluation were performed.
    Results The patient with severe BMMI benefited greatly from rehabilitation, with a 15-point reduction in the NIHSS score, a 68-point improvement in the Modified Barthel score, and a 3-point reduction in the MRS score. Diaphragm ultrasound suggested that the diaphragm thickening ratio increased from 20% to 68%, and diaphragm mobility increased from 21.6 mm to 28.8 mm. As of the follow-up date, the patient was able to sit independently and stand with little assistance.
    Conclusion Early, comprehensive, and full-course rehabilitation may have a positive effect on the prognosis of patients with severe BMMI.

     

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