Kitisomprayoonkul Wasuwat, Sungkapo Peeraporn, Taveemanoon Suganya, Chaiwanichsiri Dootchai
Department of Rehabilitation Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2010 May;93(5):594-600.
To identify the incidence and risk factors of medical complications during inpatient stroke rehabilitation.
Stroke patients (n = 118) admitted to the Thai Red Cross Rehabilitation Center between August 2006 and January 2007 were prospectively evaluated throughout inpatient rehabilitation to identify incidence of complications.
Eighty-three patients (70.3%) experienced at least one complication. The common complications were post-stroke depression (56.6%), musculoskeletal pain (28%), urinary tract infection (UTI) (17.8%), and complex regional pain syndrome (CRPS) type I (15.3%). Others were pneumonia (4.2%), cardiovascular complications (4.2%), falls (4.2%), upper GI bleeding (3.2%), seizure (2.5%), and pressure ulcer (1.7%). Fourteen patients (11.8%) were referred to the acute care hospital because of severe medical complications. History of myocardial infarction, low admission Barthel ADL Index, urinary incontinence, indwelling catheterization, and dysphagia were risk factors of complications (p < 0.05). There were no specific risk factors of post-stroke depression. The risk factor of UTI was indwelling catheterization (RR 78.86, p < 0.001), CRPS type I was limited shoulder range of motion (RR 3.13, p = 0.035), pneumonia was aspiration (RR 145.33, p < 0.001), and cardiovascular complication was history of myocardial infarction (RR 7.70, p = 0.037).
The incidence of medical complication is 70.3%. Post-stroke depression, musculoskeletal pain, UTI and CRPS type I are the common complications. The risk factors of complications are low admission BAI, history of myocardial infarction, urinary incontinence, indwelling catheterization, and dysphagia. Awareness and screening of risk factors should be implemented to lower the incidence.
确定住院脑卒中康复期间医疗并发症的发生率及危险因素。
对2006年8月至2007年1月入住泰国红十字会康复中心的脑卒中患者（n = 118例）在整个住院康复期间进行前瞻性评估，以确定并发症的发生率。
83例患者（70.3%）至少发生一种并发症。常见并发症为脑卒中后抑郁（56.6%）、肌肉骨骼疼痛（28%）、尿路感染（UTI）（17.8%）和I型复杂性区域疼痛综合征（CRPS）（15.3%）。其他并发症包括肺炎（4.2%）、心血管并发症（4.2%）、跌倒（4.2%）、上消化道出血（3.2%）、癫痫发作（2.5%）和压疮（1.7%）。14例患者（11.8%）因严重医疗并发症被转诊至急症医院。心肌梗死病史、入院时Barthel日常生活活动指数较低、尿失禁、留置导尿和吞咽困难是并发症的危险因素（p < 0.05）。脑卒中后抑郁无特定危险因素。UTI的危险因素是留置导尿（相对危险度78.86，p < 0.001），I型CRPS是肩关节活动范围受限（相对危险度3.13，p = 0.035），肺炎是误吸（相对危险度145.33，p < 0.001），心血管并发症是心肌梗死病史（相对危险度7.70，p = 0.037）。
医疗并发症的发生率为70.3%。脑卒中后抑郁、肌肉骨骼疼痛、UTI和I型CRPS是常见并发症。并发症的危险因素是入院时BAI较低、心肌梗死病史、尿失禁、留置导尿和吞咽困难。应开展危险因素的识别和筛查以降低发生率。
