Sundseth Antje, Thommessen Bente, Rønning Ole Morten
Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway.
J Stroke Cerebrovasc Dis. 2014 Mar;23(3):496-9. doi: 10.1016/j.jstrokecerebrovasdis.2013.04.012. Epub 2013 May 13.
Treatment in stroke units reduces mortality and disability compared with treatment in general medical wards. Early mobilization is considered one element of stroke unit care contributing to this benefit. There are uncertainties regarding the effect of this approach on different groups of acute stroke patients. In this study, we compared the proportions of patients having a modified Rankin Scale score ≤2 assessed 3 months poststroke in patients mobilized within 24 hours versus between 24 to 48 hours of hospitalization, and explored whether other factors were associated with good outcome.
Patients hospitalized within 24 hours of stroke onset were enrolled in this prospective, randomized, controlled trial with blinded outcome assessment. They were assigned to 2 groups; 1 that was mobilized within 24 hours of admittance and 1 that was mobilized 24 to 48 hours after admittance. Binary logistic regression was performed to analyze predictors of good outcome, with stepwise elimination of nonsignificant variables in the multivariate model. Candidate variables were mobilization within 24 hours of admittance, age, sex, stroke risk factors, and National Institutes of Health Stroke Scale score on admittance.
Twenty-seven patients were mobilized within 24 hours of hospitalization and 25 between 24 and 48 hours. The median times to first mobilization were 7.5 hours (interquartile range 2.5-16.3) and 30.0 hours (interquartile range 25.5-38.0), respectively. Fifty-five percent of patients had a good outcome. None of the candidate variables had a significant association with good outcome.
Neither time to mobilization nor any other candidate variable was associated with good outcome 3 months poststroke.
与在普通内科病房治疗相比，在卒中单元进行治疗可降低死亡率和残疾率。早期活动被认为是卒中单元护理的一个要素，有助于实现这一益处。这种方法对不同组急性卒中患者的影响存在不确定性。在本研究中，我们比较了在卒中后3个月时改良Rankin量表评分≤2的患者比例，这些患者分别是在住院24小时内进行活动的与在住院24至48小时之间进行活动的，并探讨了是否有其他因素与良好预后相关。
在卒中发作24小时内住院的患者被纳入这项前瞻性、随机、对照试验，结局评估采用盲法。他们被分为两组；一组在入院24小时内进行活动，另一组在入院24至48小时后进行活动。进行二元逻辑回归分析以分析良好预后的预测因素，在多变量模型中逐步剔除无显著意义的变量。候选变量包括入院24小时内进行活动、年龄、性别、卒中危险因素以及入院时的美国国立卫生研究院卒中量表评分。
27例患者在住院24小时内进行了活动，25例在24至48小时之间进行了活动。首次活动的中位时间分别为7.5小时（四分位间距2.5 - 16.3）和30.0小时（四分位间距25.5 - 38.0）。55%的患者预后良好。没有一个候选变量与良好预后有显著关联。
卒中后3个月时，活动时间以及任何其他候选变量均与良好预后无关。
