早期活動介入於蜘珠腦膜下腔出血併發顱內出血個案之報告

Early Mobilization Intervention in a Case of Subarachnoid Hemorrhage Complicated with Intracerebral Hemorrhage

蜘珠腦膜下腔出血的病人於初期更需小心預防血管孿縮、發炎、血腦屏障破損所導致的大腦水腫、 癲癇發作及延遲性的大腦缺血等問題，另可能有低血鈉症、血容積不足及心臟功能不全等系統性併發症。 因此，針對蜘珠腦膜下腔出血病人早期活動介入，更需注意其可活動之條件。本篇個案是一位右額頂葉蜘珠腦膜下腔出血併發左側殼核內出血的45歲女性，於2016年5月時被送至急診室，腦部電腦斷層顯示右額頂葉蜘珠網膜下腔出血，於5日後又發生左邊殼核出血，而後進行呼吸器的移除訓練，於七週後 轉入一般病房，且開始接受亞急性期床邊物理治療，約八周後轉入復健病房。本篇使用「國際功能、失能和健康分類模式」評估分析個案，發現個案在活動及參與部分，亞急性期主要受限於坐姿平衡不佳， 進而分析相關機能損傷的不利因素。同時也發現合作度及注意力表現等身體功能與結構損傷層面因子亦會影響病人表現。經一週床邊早期活動介入後，個案功能活動表現有顯著的進步。

Patients of subarachnoid hemorrhage (SAH) should be careful to prevent vasospasm, inflammation, global cerebral edema due to a ruptured blood-brain barrier, seizures and delayed cerebral ischemia at the initial phase. Other systemic complications are also possible, including hyponatremia, intravascular volume depletion and cardiac dysfunction. Therefore, as to implementing early mobilization on individuals with SAH, it is exceedingly crucial to scrutinize their eligibility for such intervention. This study examined the case of a 45 years-old female who had right frontal-parietal SAH complicated with left putamen intracerebral hemorrhage. In May 2016, she was sent to an emergency room where a brain CT showed right frontal-parietal SAH, and she suffered a left putamen intracerebral hemorrhage after 5 days of onset. She was weaned from ventilator support afterwards, and was transferred to the general ward after 7 weeks of onset. She began to receive bedside physical therapy, and then was transferred to the rehabilitation ward after 8 weeks of onset. This study used the International Classification of Functioning, Disability and Health (ICF) model to analyze this case, and found that activity and participation at the sub-acute phase was mainly limited by poor sitting balance. The barriers related to functional impairments were then further analyzed. It was also found that the factors of body function and structure impairment level, such as attention and cooperation, can affect a patient’s performance. After one-week of early mobilization intervention at bedside, there was significant progress in the patient’s performance of functional activities