Rickenbacher P, Lyrer P, Schweikert K, Operschall C, Steck A, Ritz R
Abteilung für Intensivmedizin, Universitätskliniken, Kantonsspital Basel.
Schweiz Med Wochenschr. 1998 Apr 25;128(17):658-64.
It has been shown that the prognosis of patients with stroke can be improved by specialized stroke units. Whether any additional benefit can be achieved by use of intensive care resources is unknown. Therefore, it was the purpose of this study to analyze our first experience of management of patients with acute ischaemic stroke in an intensive care unit, as part of a newly implemented coordinated stroke concept.
A consecutive series of 88 patients with acute ischemic stroke (age 64.4 +/- 14.2 years, 28% females) hospitalized in a medical intensive care unit according to predefined criteria formed the study population. The goals were to monitor vital functions, to complete diagnostic studies in timely fashion and to prevent and treat complications.
The patients were hospitalized in the intensive care unit for a mean period of 34.4 +/- 19.5 hours. Relevant pathologic findings included systolic hypertension > 220 mm Hg in 5% and permanent or intermittent relative systolic hypotension < 150 mm Hg in 25% and 98% of patients respectively. One patient (1%) died during the stay. Additional diagnostic studies were performed more often in patients with progressive or fluctuating symptoms (100% of patients in each group) than in those with improving or stable symptoms (50% of patients in each group). Fourteen percent of patients were treated for hypertension and 30% for hypotension. Antithrombotic therapy with aspirin was started in 34%, prophylaxis for venous thrombosis with low dose heparin in 39% and systemic anticoagulation in 40% of patients respectively. No cardiac or pulmonary complications requiring treatment were observed and no specific therapies for neurologic complications were utilized. At the time of discharge from the intensive care unit, 88% of patients showed improved or stable neurologic findings.
In the present analysis, an unexpectedly high incidence of relative arterial hypotension was observed in patients hospitalized in an intensive care unit for acute ischaemic stroke. Therapeutic measures were restricted mainly to blood pressure control and anticoagulation/antithrombotic treatment. Specific therapies for neurologic complications or interventions requiring the resources of an intensive care unit were not used. Whether defined patient groups with ischaemic stroke will benefit from specific treatment in an intensive care unit needs to be tested by controlled, randomized studies.
已有研究表明，专业的卒中单元可改善卒中患者的预后。使用重症监护资源是否能带来额外益处尚不清楚。因此，本研究旨在分析我们在重症监护病房对急性缺血性卒中患者进行管理的首次经验，这是新实施的协同卒中概念的一部分。
根据预定义标准，在医疗重症监护病房连续收治的88例急性缺血性卒中患者（年龄64.4±14.2岁，女性占28%）构成了研究人群。目标是监测生命功能、及时完成诊断检查并预防和治疗并发症。
患者在重症监护病房的平均住院时间为34.4±19.5小时。相关病理发现包括，分别有5%的患者收缩压>220 mmHg，25%和98%的患者出现永久性或间歇性相对收缩压<150 mmHg。1例患者（1%）在住院期间死亡。症状进行性加重或波动的患者（每组100%的患者）比症状改善或稳定的患者（每组50%的患者）更常进行额外的诊断检查。14%的患者接受了高血压治疗，30%的患者接受了低血压治疗。分别有34%的患者开始使用阿司匹林进行抗栓治疗，39%的患者使用低剂量肝素预防静脉血栓形成，40%的患者进行全身抗凝。未观察到需要治疗的心脏或肺部并发症，也未使用针对神经并发症的特异性治疗方法。从重症监护病房出院时，88%的患者神经功能表现改善或稳定。
在本分析中，入住重症监护病房的急性缺血性卒中患者中，相对动脉低血压的发生率意外地高。治疗措施主要限于血压控制和抗凝/抗栓治疗。未使用针对神经并发症的特异性治疗方法或需要重症监护资源的干预措施。缺血性卒中的特定患者群体是否能从重症监护病房的特异性治疗中获益，需要通过对照、随机研究来验证。
