延长卒中单元服务并早期支持出院的益处：一项随机对照试验。

Benefit of an extended stroke unit service with early supported discharge: A randomized, controlled trial.

作者信息

Indredavik B, Fjaertoft H, Ekeberg G, Løge A D, Mørch B

机构信息

Stroke Unit, Department of Medicine, University Hospital of Trondheim (Norway).

出版信息

Stroke. 2000 Dec;31(12):2989-94. doi: 10.1161/01.str.31.12.2989.

DOI:10.1161/01.str.31.12.2989

PMID:11108761

Abstract

BACKGROUND AND PURPOSE

Several trials have shown that stroke unit care improves outcome for stroke patients. The aim of the present trial was to evaluate the effects of an extended stroke unit service (ESUS), with early supported discharge, cooperation with the primary healthcare system, and more emphasis on rehabilitation at home as essential elements.

METHODS

In a randomized, controlled trial, 160 patients with acute stroke were allocated to the ESUS and 160 to the ordinary stroke unit service (OSUS). The primary outcome was the proportion of patients who were independent as assessed by the modified Rankin Scale (RS) (RS </=2=global independence) and independent in activities of daily living (ADL) as assessed by Barthel Index (BI) (BI >/=95=independent in ADL) after 26 weeks. Secondary outcomes were RS and BI scores after 6 weeks; the proportion of patients at home, in institutions, and deceased after 6 and 26 weeks; and the length of stay in institutions.

RESULTS

After 26 weeks, 65.0% in the ESUS versus 51.9% in the OSUS group showed global independence (RS </=2) (P:=0.017), while 60.0% in the ESUS versus 49.4% in the OSUS group were independent in ADL (BI >/=95) (P:=0.056). The odds ratios for independence (ESUS versus OSUS) were as follows: RS, 1.72 (95% CI, 1.10 to 2.70); BI, 1.54 (95% CI, 0.99 to 2.39). At 6 weeks, 54.4% of the ESUS group and 45. 6% of the OSUS group were independent according to RS (P:=0.118), and 56.3% versus 48.8% were independent according to BI (P:=0.179). The proportion of patients at home after 6 weeks was 74.4% for ESUS and 55.6% for OSUS (P:=0.0004), and the proportion in institutions was 23.1% versus 40.0%, respectively (P:=0.001). After 26 weeks, 78. 8% in the ESUS group versus 73.1% in the OSUS were at home (P:=0. 239), while 13.1% versus 17.5% were in institutions (P:=0.277). The mortality in the 2 groups did not differ. Average lengths of stay in an institution were 18.6 days in the ESUS and 31.1 days in the OSUS group (P:=0.0324).

CONCLUSIONS

An ESUS with early supported discharge seems to improve functional outcome and to reduce the length of stay in institutions compared with traditional stroke unit care.

摘要

背景与目的

多项试验表明，卒中单元护理可改善卒中患者的预后。本试验的目的是评估一种扩展卒中单元服务（ESUS）的效果，该服务以早期辅助出院、与基层医疗系统合作以及更加强调家庭康复为基本要素。

方法

在一项随机对照试验中，160例急性卒中患者被分配至ESUS组，160例被分配至普通卒中单元服务（OSUS）组。主要结局是26周后根据改良Rankin量表（RS）评估为独立（RS≤2 = 完全独立）且根据Barthel指数（BI）评估在日常生活活动（ADL）中独立（BI≥95 = 在ADL中独立）的患者比例。次要结局是6周后的RS和BI评分；6周和26周后在家、在机构及死亡的患者比例；以及在机构的住院时间。

结果

26周后，ESUS组65.0%的患者与OSUS组51.9%的患者表现为完全独立（RS≤2）（P = 0.017），而ESUS组60.0%的患者与OSUS组49.4%的患者在ADL中独立（BI≥95）（P = 0.056）。独立的优势比（ESUS组与OSUS组相比）如下：RS为1.72（95%CI，1.10至2.70）；BI为1.54（95%CI，0.99至2.39）。6周时，根据RS，ESUS组54.4%的患者和OSUS组45.6%的患者独立（P = 0.118），根据BI，分别为56.3%和48.8%（P = 0.179）。6周后ESUS组在家患者比例为74.4%，OSUS组为55.6%（P = 0.0004），在机构的患者比例分别为23.1%和40.0%（P = 0.001）。26周后，ESUS组78.8%的患者与OSUS组73.1%的患者在家（P = 0.239），而在机构的患者比例分别为13.1%和17.5%（P = 0.277）。两组的死亡率无差异。ESUS组在机构的平均住院时间为18.6天，OSUS组为31.1天（P = 0.0324）。