3049例脑卒中患者康复住院日的影响因素分析

Factors Related with Length of Stay for Inpatient Rehabilitation after Stroke

目的：分析脑卒中患者康复住院日趋势及其影响因素。方法连续选取北京博爱医院2002年1月-2011年12月住院康复脑卒中患者共3049例，进行回顾性分析。采用秩和检验、二分类Logistic回归模型进行统计学分析，探讨住院日的影响因素。结果脑卒中患者康复住院日中位数为82 d，2010年、2011年住院日有明显下降趋势。Logistic回归共筛选出13个变量，手术、肌肉痉挛、日常生活活动能力评分增加值、发病时间、院内感染、并发症、言语障碍、卒中类型、住院次数、付费方式为住院日的危险因素，年龄段、步行功能分级、Fugl-Meyer评分为保护因素。结论降低住院日要以康复效果为参照指标，通过改善医院管理流程，加强并发症预防和院感控制，早期康复介入，从而降低住院日。

Objective To investigate the trend of length of stay （LOS） and identify variables that predict LOS for inpatient rehabilitation after stroke. Methods A total of 3049 inpatients who completed the stroke rehabilitation program at Beijing Bo＇ai Hospital from January 2002 to December 2011 were reviewed and analyzed with nonparametric rank sum test and binary Logistic regression analysis. Results The median of LOS was 82 days, and tended to decrease obviously in 2010 and 2011. On Logistic regression analysis, there were 13 variables as-sociated with LOS, in which operation, muscle spasm, gain of activities of daily living （ADL）, onset admission interval, nosocomial infec-tion, complications, speech disorder, the type of stroke, the number of hospitalization, methods of payment were the risk factors, and age, functional ambulation classificateion and Fugl-Meyer Assessment were protect factors. Conclusion Reducing LOS must base on rehabilita-tion efficacy, and the improvement of hospital management process, the prevention of complications and nosocomial infection control, and early rehabilitation intervention can reduce the LOS.