重症监护病房中重度获得性脑损伤的早期康复：多中心观察性研究。

Early rehabilitation for severe acquired brain injury in intensive care unit: multicenter observational study.

作者信息

Bartolo Michelangelo, Bargellesi Stefano, Castioni Carlo A, Bonaiuti Donatella, Antenucci Roberto, Benedetti Angelo, Capuzzo Valeria, Gamna Federica, Radeschi Giulio, Citerio Giuseppe, Colombo Carolina, Del Casale Laura, Recubini Elena, Toska Saimir, Zanello Marco, D'Aurizio Carlo, Spina Tullio, Del Gaudio Alredo, Di Rienzo Filomena, Intiso Domenico, Dallocchio Giulia, Felisatti Giovanna, Lavezzi Susanna, Zoppellari Roberto, Gariboldi Valentina, Lorini Luca, Melizza Giovanni, Molinero Guido, Mandalà Giorgio, Pignataro Amedeo, Montis Andrea, Napoleone Alessandro, Pilia Felicita, Pisu Marina, Semerjian Monica, Pagliaro Giuseppina, Nardin Lorella, Scarponi Federico, Zampolini Mauro, Zava Raffaele, Massetti Maria A, Piccolini Carlo, Aloj Fulvio, Antonelli Sergio, Zucchella Chiara

机构信息

Neurorehabilitation Unit IRCCS INM Neuromed, Pozzilli (IS), Italy -

出版信息

Eur J Phys Rehabil Med. 2016 Feb;52(1):90-100. Epub 2015 Nov 4.

PMID:26530213

Abstract

BACKGROUND

The increased survival after a severe acquired brain injury (sABI) raise the problem of making most effective the treatments in Intensive Care Unit (ICU)/Neurointensive Care Unit (NICU), also integrating rehabilitation care. Despite previous studies reported that early mobilization in ICU was effective in preventing complications and reducing hospital stay, few studies addressed the rehabilitative management of sABI patients in ICU/NICU.

AIM

To collect clinical and functional data about the early rehabilitative management of sABI patients during ICU/NICU stay.

DESIGN

Prospective, observational, multicenter study.

SETTING

Fourteen facilities supplied by intensive neurorehabilitation units and ICU/NICUs.

POPULATION

Consecutive sABI patients admitted to ICU/NICU.

METHODS

Patients were evaluated at admission and then every 3-5 days. Clinical, functional and rehabilitative data, including Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), The Rancho Los Amigos Levels of Cognitive Functioning Scale (LCF), Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome scale (GOS) and Functional Independence Measure (FIM) were collected.

RESULTS

One hundred and two patients (F/M 44/58) were enrolled. The mean duration of ICU stay was 24.7±13.9 days and the first rehabilitative evaluation occurred after 8.7±8.8 days. Regular postural changes and multijoint mobilization were prescribed in 63.7% and 64.7% cases, respectively. The mean session duration was 38±11.5 minutes. Swallowing evaluation was performed in 14.7% patients, psychological support was provided to 12.7% of patients' caregivers, while 17.6% received a psycho-educational intervention, and 28.4% were involved in interdisciplinary team meetings. The main discharge destinations were Severe Acquired Brain Injury rehabilitation units for 43.7%, intensive neurorehabilitation units for 20.7%.

CONCLUSIONS

Data showed that early rehabilitation was not diffusely performed in sABI subjects in ICU/NICU and rehabilitative interventions were variable; one-third of subjects were not referred to dedicated rehabilitation unit at discharge.

CLINICAL REHABILITATION IMPACT

The study stresses the need to spread and implement a rehabilitative culture also for critical ill patients due to neurological diseases.

摘要

背景

严重获得性脑损伤（sABI）患者生存率的提高引发了如何在重症监护病房（ICU）/神经重症监护病房（NICU）使治疗最有效的问题，同时还需整合康复护理。尽管先前的研究报告称，ICU中的早期活动对预防并发症和缩短住院时间有效，但很少有研究涉及ICU/NICU中sABI患者的康复管理。

目的

收集关于sABI患者在ICU/NICU住院期间早期康复管理的临床和功能数据。

设计

前瞻性、观察性、多中心研究。

地点

由神经强化康复单元和ICU/NICU提供服务的14个机构。

研究对象

连续入住ICU/NICU的sABI患者。

方法

患者在入院时进行评估，随后每3 - 5天评估一次。收集临床、功能和康复数据，包括格拉斯哥昏迷量表（GCS）、残疾评定量表（DRS）、兰乔斯阿米戈斯认知功能水平量表（LCF）、早期康复巴氏指数（ERBI）、格拉斯哥预后量表（GOS）和功能独立性测量（FIM）。

结果

共纳入102例患者（男44例/女58例）。ICU平均住院时间为24.7±13.9天，首次康复评估在8.7±8.8天后进行。分别有63.7%和64.7%的病例规定了定期体位改变和多关节活动。平均治疗时长为38±11.5分钟。14.7%的患者进行了吞咽评估，12.7%的患者家属得到了心理支持，17.6%的患者接受了心理教育干预，28.4%的患者参加了跨学科团队会议。主要出院去向为重度获得性脑损伤康复单元的占43.7%，神经强化康复单元的占20.7%。