Ong Poo Lee, Seah Justin Desheng, Chua Karen Sui Geok
Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore 569766, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore.
Life (Basel). 2023 Aug 18;13(8):1766. doi: 10.3390/life13081766.
Haemorrhagic stroke, accounting for 10-20% of all strokes, often requires decompressive surgery as a life-saving measure for cases with massive oedema and raised intracranial pressure. This study was conducted to compare the demographics, characteristics and rehabilitation profiles of patients with severe haemorrhagic stroke who were managed surgically versus those who were managed non-surgically.
A single-centre retrospective study of electronic medical records was conducted over a 3-year period from 1 January 2018 to 31 December 2020. The inclusion criteria were first haemorrhagic stroke, age of >18 years and an admission Functional Independence Measure (FIM™) score of 18-40 upon admission to the rehabilitation centre. The primary outcome measure was discharge FIM™. Secondary outcome measures included modified Rankin Scale (mRS), rehabilitation length of stay (RLOS) and complication rates.
A total of 107 patients' records were analysed; 45 (42.1%) received surgical intervention and 62 (57.9%) patients underwent non-surgical management. Surgically managed patients were significantly younger than non-surgical patients, with a mean age of [surgical 53.1 (SD 12) vs. non-surgical 61.6 (SD 12.3), = 0.001]. Admission FIM was significantly lower in the surgical vs. non-surgical group [23.7 (SD6.7) vs. 26.71 (SD 7.4), = 0.031). However, discharge FIM was similar between both groups [surgical 53.91 (SD23.0) vs. non-surgical 57.0 (SD23.6), = 0.625). Similarly, FIM gain (surgical 30.1 (SD 21.1) vs. non-surgical 30.3 (SD 21.1), = 0.094) and RLOS [surgical 56.2 days (SD 21.5) vs. non-surgical 52.0 days (SD 23.4), = 0.134) were not significantly different between groups. The majority of patients were discharged home (surgical 73.3% vs. non-surgical 74.2%, = 0.920) despite a high level of dependency.
Our findings suggest that patients with surgically managed haemorrhagic stroke, while older and more dependent on admission to rehabilitation, achieved comparable FIM gains, discharge FIM and discharge home rates after ~8 weeks of rehabilitation. This highlights the importance of rehabilitation, especially for surgically managed haemorrhagic stroke patients.
出血性中风占所有中风病例的10%-20%，对于出现严重水肿和颅内压升高的病例，通常需要进行减压手术作为挽救生命的措施。本研究旨在比较接受手术治疗与非手术治疗的严重出血性中风患者的人口统计学特征、特点及康复情况。
对2018年1月1日至2020年12月31日这3年期间的电子病历进行单中心回顾性研究。纳入标准为首次出血性中风、年龄大于18岁且入住康复中心时的功能独立性评定量表（FIM™）评分为18-40分。主要结局指标为出院时的FIM™评分。次要结局指标包括改良Rankin量表（mRS）、康复住院时间（RLOS）和并发症发生率。
共分析了107例患者的记录；45例（42.1%）接受了手术干预，62例（57.9%）患者接受了非手术治疗。接受手术治疗的患者明显比非手术患者年轻，平均年龄为[手术组53.1（标准差12）对非手术组61.6（标准差12.3），P = 0.001]。手术组入院时的FIM评分明显低于非手术组[23.7（标准差6.7）对26.71（标准差7.4），P = 0.031]。然而，两组出院时的FIM评分相似[手术组53.91（标准差23.0）对非手术组57.0（标准差23.6），P = 0.625]。同样，两组间FIM评分的提高幅度[手术组30.1（标准差21.1）对非手术组30.3（标准差21.1），P = 0.094]和康复住院时间[手术组56.2天（标准差21.5）对非手术组52.0天（标准差23.4），P = 0.134]无显著差异。尽管患者依赖程度较高，但大多数患者出院回家（手术组73.3%对非手术组74.2%，P = 0.920）。
我们的研究结果表明，接受手术治疗的出血性中风患者，虽然年龄较大且入住康复中心时依赖性更强，但经过约8周的康复后，在FIM评分提高幅度、出院时FIM评分及出院回家率方面取得了相似的结果。这凸显了康复的重要性，尤其是对于接受手术治疗的出血性中风患者。
