Kalra L, Yu G, Wilson K, Roots P
Orpington Stroke Unit, Bromley Hospitals NHS Trust, UK.
Stroke. 1995 Jun;26(6):990-4. doi: 10.1161/01.str.26.6.990.
We sought to evaluate the effect of setting on the rate of medical complications during stroke rehabilitation.
A study of the frequency and nature of medical complications in stroke rehabilitation was undertaken in 245 patients managed either on a stroke rehabilitation unit (n = 124) or on general medical wards (n = 121). The stroke unit setting was characterized by established protocols for prevention, early diagnosis, and management of complications (eg, aspiration, infections, thromboembolism, pressure sores, depression, stroke progression). Similar protocols did not exist on general medical wards except for thromboembolism, pressure sores, and secondary stroke prevention.
Medical complications were documented in 147 patients (60%) and were more common in patients with severe strokes (97%). The frequency of reported complications was similar in both settings. Aspiration (33% versus 20%; P < .01) and musculoskeletal pain (38% versus 23%; P < .05) were more commonly documented on the stroke unit, whereas urinary problems (18% versus 7%; P < .01) and infections (49% versus 25%; P < .01) were more commonly seen on general medical wards. The reported frequency of deep vein thrombi, pressure sores, and stroke progression was similar in both settings. Although depression was reported equally in both settings (34% on the stroke unit versus 27% on general wards), patients on the stroke unit were more likely to be treated compared with general wards (67% versus 36%; P < .05).
The study shows that inpatient stroke rehabilitation is a medically active service. Management on specialist units is associated with earlier detection and management of stroke-related problems and prevention of potentially life-threatening complications.
我们试图评估中风康复期间不同治疗环境对医疗并发症发生率的影响。
对245例中风康复患者进行了医疗并发症发生频率及性质的研究，这些患者分别在中风康复单元（n = 124）或普通内科病房（n = 121）接受治疗。中风单元的特点是制定了预防、早期诊断和处理并发症（如吸入性肺炎、感染、血栓栓塞、压疮、抑郁、中风进展）的既定方案。普通内科病房除血栓栓塞、压疮和二级中风预防外，不存在类似方案。
147例患者（60%）有医疗并发症记录，在重症中风患者中更常见（97%）。两种治疗环境下报告的并发症发生率相似。吸入性肺炎（33%对20%；P < 0.01）和肌肉骨骼疼痛（38%对23%；P < 0.05）在中风单元更常见，而泌尿系统问题（18%对7%；P < 0.01）和感染（49%对25%；P < 0.01）在普通内科病房更常见。两种治疗环境下深静脉血栓、压疮和中风进展的报告发生率相似。尽管两种治疗环境下抑郁的报告率相同（中风单元为34%，普通病房为27%），但与普通病房相比，中风单元的患者接受治疗的可能性更高（67%对36%；P < 0.05）。
该研究表明住院中风康复是一项医疗活动频繁的服务。在专科单元进行管理与更早发现和处理中风相关问题以及预防潜在的危及生命的并发症相关。
