ICU脑卒中康复干预的针对措施和短期结局

Correspond measures of rehabilitation intervention in stroke patients in intensive care unit and the outcome in short term

目的 :探讨重症脑卒中的干预措施和近期目标 ,以及重症和早期康复医疗的临床意义。方法 :对患者进行临床评定 ,包括主要病情、监护指标、心功能、Glasgow昏迷量表 (GCS)、简式Fugl-Mayer评估 (FMA)等 ,对康复干预可能引起的反应和产生影响的监护指标进行观测。针对不同监护下状态采用适当康复干预措施。结果 :在本组中风ICU的主要合并症和并发症中 ,肺部感染占 73 .52 % ;心脏疾患占 38.2 4 % ;糖尿病占 2 6 .47%。虽然在康复干预后患者的运动功能仍然较低 ,但治疗组患者在实施康复治疗后GCS评分明显提高 (P <0 .0 0 1 ) ,而对照组改善不明显。治疗组FMA和对照组FMA在治疗后都有明显提高 ,而治疗组上下肢运动功能改善优于对照组 (P <0 .0 5)。结论 :ICU脑卒中患者有神经系统和心肺等方面的复杂问题 ,应采取针对性的对策 。

Objective: To investigate measures of rehabilitation intervention and short goal for severe stroke patients in ICU, and prove the clinical significance of early medical rehabilitation in severe patients. Method: Vital signs, heart function, monitor signs effected by the intervention with GCS and FMA were evaluated and observed before and after early rehabilitation that was performed to severe stroke patients in ICU. Result: In major incorporations and complications in the stroke ICU, lung fever is about 73.52%; heart disease is 38.24%; diabetes is 26.47% before the intervention. The study showed GCS in the study group compared to in control group after treatment was improvement significantly ( P <0.001) then in the control group. Although the motion function of the patients in ICU remained lower after intervention, the scores of FMA was improved in both study and control group. The motion function of upper and lower extremities in study group compared to control group was obviously improved after intervention ( P <0.05). Conclusion: Early rehabilitation of severe stroke patients in ICU have the rehabilitation potential and value on the basis of observing the function status of stroke patients while transfer from ICU to general unit. The correspond measures of early rehabilitation must be conducted according to the difference sings, that is abnormal or/and relative steady because of the complexity of nervous system and cardiopneumatic diseases on stroke patients in ICU.