Indredavik Bent, Rohweder Gitta, Naalsund Eirik, Lydersen Stian
Stroke Unit, Department of Medicine, University Hospital of Trondheim, Olav Kyrres gt 17, N-7006 Trondheim, Norway.
Stroke. 2008 Feb;39(2):414-20. doi: 10.1161/STROKEAHA.107.489294. Epub 2007 Dec 20.
The aims of the study were to examine the frequency and timing of predefined medical complications in unselected acute stroke patients treated in an acute comprehensive stroke unit and an early supported discharge service.
Four hundred eighty-nine acute stroke patients were included and followed up with assessments of 16 prespecified complications during the first week. Two hundred forty-four of the patients were randomly allocated to a 3-month follow-up.
During the first week, 312 of 489 patients (63.8%) experienced 1 or more complications. The most common complications were pain in 117 patients (23.9%), temperature >or=38 degrees C in 116 (23.7%), progressing stroke in 90 (18.4%), urinary tract infection in 78 (16.0%), troponin T elevation without criteria of myocardial infarction in 57 (11.7%), chest infections in 55 (11.2%), nonserious falls in 36 (7.4%), and myocardial infarction in 22 (4.5%), whereas stroke recurrence, seizure, deep venous thrombosis, pulmonary embolism, shoulder pain, serious falls, other infections, and pressure sores were each present in <or=2.5% of patients. During the 3-month follow-up, 201 of 244 patients (82.4%) experienced at least 1 complication, the most common of which was pain, which occurred in 134 patients (53.3%), followed by urinary tract infection in 68 (27.9%) and nonserious falls in 61 (25.0%). The severity of stroke on admission was the most important risk factor for developing complications.
This is the first study of complications in unselected acute stroke patients treated in a comprehensive stroke unit and early supported discharge service and shows that pain, progressing stroke, infections, myocardial infarction, and falls are common complications, whereas others occur infrequently. Most complications occur during the first 4 days, and stroke severity is the most important risk factor.
本研究旨在调查在急性综合卒中单元及早期支持出院服务中接受治疗的未经筛选的急性卒中患者中，预设医疗并发症的发生频率及时间。
纳入489例急性卒中患者，并在第一周内对16种预先设定的并发症进行评估随访。其中244例患者被随机分配至3个月的随访。
在第一周内，489例患者中有312例（63.8%）发生1种或更多并发症。最常见的并发症为：117例患者疼痛（23.9%）、116例体温≥38℃（23.7%）、90例病情进展性卒中（18.4%）、78例尿路感染（16.0%）、57例肌钙蛋白T升高但无心肌梗死标准（11.7%）、55例肺部感染（11.2%）、36例非严重跌倒（7.4%）、22例心肌梗死（4.5%），而卒中复发、癫痫、深静脉血栓形成、肺栓塞、肩部疼痛、严重跌倒、其他感染及压疮在患者中的发生率均≤2.5%。在3个月的随访中，244例患者中有照201例（82.4%）发生至少1种并发症，其中最常见的是疼痛，134例患者出现疼痛（53.3%），其次是尿路感染68例（27.9%）和非严重跌倒61例（25.0%）。入院时卒中的严重程度是发生并发症的最重要危险因素。
这是首次对在综合卒中单元及早期支持出院服务中接受治疗的未经筛选的急性卒中患者并发症进行的研究，结果显示疼痛、病情进展性卒中、感染、心肌梗死及跌倒为常见并发症，而其他并发症发生率较低。大多数并发症发生在最初4天内，且卒中严重程度是最重要的危险因素。
