综合性卒中单元对急性卒中后肺炎影响的研究

Effect of comprehensive stroke unit on patients with pneumonia after acute stroke

目的研究综合性卒中单元对急性卒中后继发肺炎患者的预后、住院时间及抗生素费用的影响。方法连续收集了159例急性卒中后(发病2周内)肺炎的住院患者,随机分组,接受综合性卒中单元治疗的为卒中单元组(77例),在神经科常规病房治疗的为对照组(82例)。评价两组患者入院时和入院后21 d的美国国立卫生院卒中量表(NIHSS)、改良Rankin量表(mRS)和Barthel指数(BI)的改善情况;并比较两组的营养不良、并发症发生率、病死率、平均住院天数及抗生素费用。结果①卒中单元组入院后21 d NIHSS、mRS、BI的改善值明显优于对照组[-(1.06±1.27),0.18±1.19;-(0.12±0.33),0.03±0.36;3.1±6.0,-(0.5±2.7)。均P<0.01]。②卒中单元组并发症、营养不良发生率分别为59.7%,32.5%,低于对照组的75.6%,48.8%,均P<0.05。③卒中单元组住院天数明显短于对照组[(36±17)d,(55±34)d,P<0.01],抗生素费用明显少于对照组[(2506±893)元,(3070±1455)元,P<0.05]。结论与在神经科常规病房治疗相比,在综合性卒中单元治疗能减少急性卒中后肺炎患者的神经功能缺损及残障程度、提高日常生活能力、减少营养不良及并发症发生率、缩短住院时间及减少抗生素费用。

Objective To study the effect of comprehensive stroke unit （SU） on patients with pneumonia after acute stroke. Methods A total of 159 consecutive inpatients with pneumonia after acute stroke （within 2 weeks after onset） were recruited randomly. The patients treated in the comprehensive SU were belong to the treatment group （n =77）, and the patients treated in the general ward （GW） of the neurological department were the control group （n = 82）. The state of patients at admission and at 21 days after admission in both groups were assessed with the National Institute of Health Stroke Scale （NIHSS）, modified Rankin Scale （mRS） and Barthel Index （BI）. The incidence of malnutrition and complication, mortality, average hospitalization days, and cost of antibiotic in both groups were compared. Results ①The improvement values of NIHSS, mRS and BI at 21 days after the admission in the treatment group were significantly better than those in the control group [-（1.06±1.27） vs. 0.18±1.19; -（0.12±0.33） vs. 0.03±0.36; 3.1±6.0 vs. -（0.50±2.71）, P〈 0. 01 all]. ②The incidence of complication and malnutrition in the treatment group were 59.7% and 32.5%, respectively, and these were lower than 75.6% and 48.8% in the control group （P 〈 0.05 all）. ③The number of hospitalization days in the treatment group was significantly shorter than that in the control group （36±17 d vs. 55±34 d, P 〈 0.01 ） ; the costs of antibiotics were significantly less than that in the control group （2506±893） yuan vs. （3070±1455） yuan, P 〈0.05）. Conclusion Compared to the GW of the neurological department, the comprehensive SU may reduce the neurological defects and the degrees of disability, improve the activities of daily living, decrease the incidences of malnutrition and complications, shorten the hospital stay, as well as lower the cost of antibiotics in patients with pneumonia after acute stroke.