联合卒中单元对脑卒中患者临床疗效的影响

The effects of an interdisciplinary approach to treating stroke patients

目的探讨联合卒中单元对脑卒中患者临床疗效的影响。方法将278例急性脑卒中患者随机分入卒中单元组和普通病房组，随访6个月。卒中单元组采用联合卒中单元管理模式进行治疗，普通病房组采用常规药物治疗。对2组病死率、日常生活活动（ADL）能力（BI评分）、神经功能（NIHSS评分）、住院时间、住院费用等指标进行评价和比较。结果卒中单元组住院病死率（4．41％）比普通病房组（10．56％）低（P〈0．01）。治疗后2组各阶段BI评分均有显著提高（P〈0．01），但卒中单元组各阶段BI评分和不同时期改善值均高于普通病房组，差异均有统计学意义（P〈0．05或0．01）。6个月时，卒中单元组ADL能力良好率高于普通病房组，而重度障碍率则明显降低（P〈0．01）。2组出院时神经功能均有改善（P〈0．01），但卒中单元组改善值更大（P〈0．01）。2组住院时间和住院总费用差异无统计学意义（P〉0．05），但卒中单元组康复费用所占比例较普通病房组高（P〈0．01）。结论与普通病房治疗相比，采取卒中单元形式进行管理能降低住院脑卒中患者的病死率，明显提高其ADL能力，降低致残率，减轻神经功能缺损，但不增加住院费用，不延长住院时间。

Objective To investigate the clinical effects of an interdisciplinary approach to the treatment of stroke patients. Methods A total of 276 acute stroke patients were admitted randomly to the stroke unit （SU） or general ward （GW）. The patients in the GW were treated with routine neurological interventions such as medication, while those in the SU were treated with an interdisciplinary approach including early positioning and such comprehensive rehabilitation interventions as physiotherapy, speech therapy and occupational therapy in addition to the routine neurological interventions. The outcome was evaluated in terms of mortality, Barthel Index （BI） scores, National Institutes of Health Stroke Scale （NIHSS） scores, length of stay （LOS） and cost. Results The mortality rate was significantly lower in the SU （4.41% ） than in the GW （ 10.56% ）. After treatment, the BI scores of both groups increased at all stages, but the BI scores of the SU group were significantly higher than those of the GW group. At discharge, NIHSS scores were significantly improved in both groups compared with those on the day of admission, but there were no significant differences between the groups with regard to the mean length of stay or the total cost. Conclusion Interdisciplinary treatment in a stroke unit can decrease mortality and neurological defects and improve the patients＇ performance of daily activities without increasing the total cost or length of stay.