卒中单元治疗脑卒中患者的模式和优越性

Pattern and superiority of stroke unit in treating patients with stroke

目的:比较卒中单元和普通病房管理模式下脑卒中患者功能恢复的不同效果。方法:2002-04/2003-05南华大学附属怀化医院神经内科、连续发病的所有急性脑卒中患者,共397例,男292例,女105例,年龄38～79,平均59.2岁。随机进入建立在神经内科的卒中单元324例和普通病房73例。卒中病房根据每个患者不同阶段实施医疗、康复训练、语言训练和心理治疗等;普通病房无标准脑血管诊断评估方案,医疗、康复和语言训练由一般内科医师担任。结果:接受卒中单元治疗的重型脑卒中患者的早期病死率(脑梗死患者为1.7%,脑出血患者为5.3%)、1年病死率(脑梗死患者为1.7%,脑出血患者为1.0%)、不良结局(脑梗死患者为30.5%,脑出血患者为32.9%)均明显小于普通病房组犤早期病死率(脑梗死患者为10.0%,脑出血患者为19.0%);1年病死率(脑梗死患者为10.0%,脑出血患者为9.5%);不良结局(脑梗死患者为65.0%,脑出血患者为66.7%)犦。康复中心接受脑卒中康复期患者304例,日常生活活动能力良好率占76.2%,与对照组(43.5%)相比差别有高度显著性意义(u=5.56,P<0.01)。结论:卒中单元是一种针对脑卒中患者诊断、治疗、护理、康复、科普教育为一体的综合性治疗模式。卒中病房对急性脑卒中患者的治疗与康复效果优于普通病房。

AIM:To compare the different effects on functional recovery between stroke patients treated in the stroke unit and general ward. METHODS:Totally 397 patients with acute infarction stroke (including 292 males and 105 females,aged 38-79 years old, and the mean age was 59.2 years old),who were admitted in the Department of Neurology,Huaihua Hospital of Nanhua University during April 2002 to May 2003,were randomized into stroke unit(n=324)and general ward(n=73).Patients in the stroke unit received medical,rehabilitative and language training and psychological treatment according to their conditions,and those in the general ward received medical,rehabilitative and language training by common physicians of internal medicine without standard diagnostic evaluation program for cardiovascular disease. RESULTS:Among the patients with severe stroke treated in the stroke unit,the early fatality rate[1.7%for patients with cerebral infarction(CI)and 5.3%for patients with cerebral hemorrhage(CH)],the fatality rate at 1 year(1.7%for CI and 1.0 for CH)and the rate of bad outcome(30.5%for CI and 32.9%for CH)were all obviously lower than those in the general ward(early fatality rate: 10.0%for CI and 19.0%for CH;fatality rate at 1 year:10.0%for CI and 9.5%for CH;bad outcome: 65.0%for CI and 66.7%for CH).The better rate for activities of daily life was 76.2%in the 304 stroke patients at the recovery phase in the Rehabilitation Center, which was highly significant different from that in the control group(43.5%)(u=5.56, P< 0.01). CONCLUSION:Stroke unit care is a comprehensive care mode with diagnosis,treatment,nursing care,rehabilitation and education,and its therapeutic and curative effects on patients with acute stroke are superior to general ward.