Meythaler J M, DeVivo M J, Braswell W C
Spain Rehabilitation Center, Department of Rehabilitation Medicine, University of Alabama School of Medicine, Birmingham 35233-7330, USA.
Am J Phys Med Rehabil. 1997 Sep-Oct;76(5):411-9. doi: 10.1097/00002060-199709000-00012.
The objective of this study was to determine associations between early variables (requirement for ventilator support, anemia, indicators of abnormal peripheral nerve function (proprioception, vibratory, fine touch/pinprick, deep-tendon reflexes, cranial nerve involvement, dysautonomia, electrodiagnostic findings), plasmapheresis, age, and gender) and outcome variables (length of acute hospitalization, length of inpatient rehabilitation, Functional Independence Measure (FIM) Rasch converted scores, and acute and rehabilitation charges) in Guillain Barré Syndrome (GBS). The design of the study was a retrospective case review of 39 GBS admissions (as defined by National Institute of Neurologic Disorders and Stroke clinical criteria) to an inpatient rehabilitation unit at a university tertiary care rehabilitation center during a three-year period. The average length of stay for 39 patients requiring transfer to the inpatient rehabilitation unit (40% of all acute care GBS admissions) was 34 days in acute care and 26 days in rehabilitation. The average adjusted charges for inpatient rehabilitation (1993 dollars) was $31,636.28. Those who required ventilator support before rehabilitation v those who did not had an admission mean FIM Rasch converted motor score of 26.6 v a score of 38.3 (P = 0.0469), gained only 10.3 points on their FIM Rasch converted motor score v 27.7 points (P = 0.0001), and had a mean acute length of stay of 66.2 days v 19.3 days (P = 0.0029). Patients requiring ventilator support were more likely to have dysautonomia (P = 0.0009). Thirty-one of 39 patients with GBS (79%) had anemia. No correlation was found between hematocrit or hemoglobin and motor function recovery as assessed via the Rasch transformed FIM motor scores. There was an association between autonomic dysfunction and an increased acute care length of stay (P = 0.0325) and total length of hospital stay (P = 0.0203). Cranial nerve dysfunction resulted in an increase in the acute care length of stay (P = 0.0266), the total length of hospital stay (P = 0.0123), and adjusted hospital charges while undergoing inpatient rehabilitation (P = 0.0235). For patients with GBS necessitating admission to inpatient rehabilitation, the requirement of prior ventilator support most strongly predicts an extended length of stay for inpatient rehabilitation.
本研究的目的是确定吉兰-巴雷综合征（GBS）早期变量（呼吸机支持需求、贫血、外周神经功能异常指标（本体感觉、振动觉、轻触觉/针刺觉、深腱反射、颅神经受累、自主神经功能障碍、电诊断结果）、血浆置换、年龄和性别）与结局变量（急性住院时间、住院康复时间、功能独立性测量（FIM）Rasch转换分数以及急性和康复费用）之间的关联。该研究的设计是对一所大学三级护理康复中心的住院康复科在三年期间收治的39例GBS患者（根据美国国立神经疾病和中风研究所临床标准定义）进行回顾性病例审查。39例需要转入住院康复科的患者（占所有急性护理GBS入院患者的40%）的平均住院时间为急性护理期34天，康复期26天。住院康复的平均调整费用（1993美元）为31,636.28美元。康复前需要呼吸机支持的患者与不需要呼吸机支持的患者相比，入院时FIM Rasch转换运动评分的平均值分别为26.6分和38.3分（P = 0.0469），FIM Rasch转换运动评分仅增加10.3分与增加27.7分（P = 0.0001），急性住院平均时间分别为66.2天和19.3天（P = 0.0029）。需要呼吸机支持的患者更有可能出现自主神经功能障碍（P = 0.0009）。39例GBS患者中有31例（79%）患有贫血。通过Rasch转换后的FIM运动评分评估，未发现血细胞比容或血红蛋白与运动功能恢复之间存在相关性。自主神经功能障碍与急性护理住院时间延长（P = 0.0325）和总住院时间延长（P = 0.0203）之间存在关联。颅神经功能障碍导致急性护理住院时间延长（P = 0.0266）、总住院时间延长（P = 0.0123）以及住院康复期间调整后的住院费用增加（P = 0.0235）。对于需要入住住院康复科的GBS患者，先前呼吸机支持的需求最能强烈预测住院康复时间延长。
