Pohl M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak D A, Platz T, Rollnik J D, Scheidtmann K, Thomas R, von Rosen F, Wallesch C W, Woldag H, Peschel P, Mehrholz J
Helios Klinik Schloss Pulsnitz, Wittgensteiner Straße 1, 01896, Pulsnitz, Deutschland.
Klinik Bavaria Kreischa, Kreischa, Deutschland.
Nervenarzt. 2016 Jun;87(6):634-44. doi: 10.1007/s00115-016-0093-1.
In Germany, neurological-neurosurgical early rehabilitation is well established in the treatment of severe neurological diseases. To develop quality standards, knowledge of the current rehabilitation course is required.
A retrospective analysis was performed on the course of rehabilitation from patients in an early neurological/neurosurgical rehabilitation program in 16 centers from 10 German states. The odds for a good or poor outcome were investigated using a multivariate logistic regression model.
Seven hundred and fifty-four patients were included in the study. The average age of the patients was 68 ± 15 years. Of the patients studied, 26 % were on mechanical ventilation commencing their neurological rehabilitation. The average duration of stay was 56 ± 51 days. Weaning rate from mechanical ventilation was 65 % and the rate of weaning from tracheal cannula was 54 %. Mean improvement in the Barthel Index of 17 points, significant reduction of dysphagia (from 62 to 30 %) and depended walking (from 99 to 82 %), and the achievement of phase C (the next stage of rehabilitation) in 38 % can still be counted as signs of successful rehabilitation. During their course of stay, near 10 % of the patients died. Of these, 67 % received solely palliative care. In the multivariate logistic models, the absence of the factor "necessity for mechanical ventilation on admission" (odds ratio 0.61; 95 % confidence interval (CI): 0.42 … 0.89) increased the chance for good outcome and the presence of this factor the risk of dying with an odds ratio of 8.07 (95 % CI: 4.54-14.34).
In spite of the severity of neurological deficits, significant functional progress has been made. These results could be interpret as positive proof of the efficacy of neurological/neurosurgical early rehabilitation programs.
在德国，神经科 - 神经外科早期康复在严重神经疾病的治疗中已得到广泛应用。要制定质量标准，需要了解当前的康复进程。
对来自德国10个州16个中心的早期神经科/神经外科康复项目患者的康复进程进行回顾性分析。使用多变量逻辑回归模型研究预后良好或不良的几率。
754名患者纳入研究。患者的平均年龄为68±15岁。在接受研究的患者中，26%在开始神经康复时使用机械通气。平均住院时间为56±51天。机械通气撤机率为65%，气管插管拔除率为54%。Barthel指数平均提高17分，吞咽困难（从62%降至30%）和依赖步行（从99%降至82%）显著减少，38%的患者达到C阶段（康复的下一阶段），这些仍可视为康复成功的迹象。在住院期间，近10%的患者死亡。其中，67%仅接受姑息治疗。在多变量逻辑模型中，不存在“入院时需要机械通气”这一因素（优势比0.61；95%置信区间(CI)：0.42…0.89）增加了预后良好的几率，而存在该因素则增加了死亡风险，优势比为8.07（95%CI：4.54 - 14.34）。
尽管神经功能缺损严重，但仍取得了显著的功能进展。这些结果可被视为神经科/神经外科早期康复项目疗效的积极证据。
