Treatment in a combined acute and rehabilitation stroke unit -: Which aspects are most important?
Treatment in a combined acute and rehabilitation stroke unit -: Which aspects are most important?
复制标题
DOI：
10.1161/01.str.30.5.917
复制
发表时间：
1999-05-01
期刊：
影响因子：
8.3
通讯作者：
Håheim, LL
中科院分区：
文献类型：
--
作者：
Indredavik, B;Bakke, F;Håheim, LL
背景和目的：我们之前的研究表明，与普通病房（GWs）相比，在我们的中风病房（SU）治疗急性卒中患者可改善短期和长期生存率和功能预后，并增加早期出院回家的可能性。本研究的目的是确定SU和GW之间的治疗差异，并评估SU护理的哪些方面对更好的结果最负责。方法：在我们的试验纳入的220例患者中，只有206例实际接受了治疗（SU， 102例；GW， 104例）。对于这些患者，我们确定了治疗的差异和治疗的后果。我们分析了我们能够测量的因素以及它们与结果的关系，6周内出院。结果：我们的特色是团队合作、员工教育、功能培训和综合理疗与护理。SU与GW的其他显著不同的治疗因素是开始系统动员/训练的时间更短，氧气、肝素、静脉生理盐水溶液和退烧药的使用增加。治疗的结果似乎是舒张压和收缩压（BP）变化较小，避免了最低的舒张压，与GW组相比，SU组的血糖和体温水平降低。单因素分析显示，除血糖水平外，所有因素均与6周内出院显著相关。在最后的多变量Cox回归模型中，较短的开始活动/训练时间和稳定的舒张压是与6周内出院显著相关的独立因素。结论：较短的活动/训练开始时间是与出院回家相关的最重要因素，其次是舒张压稳定，表明这些因素可能是SU治疗的重要因素。SU的特征的影响，如受过特殊训练的员工、团队合作和亲属的参与，是不可能测量的。这些因素可能比实际测量的因素更重要。
Background and Purpose-We have previously shown that treatment of acute stroke patients in our stroke unit (SU) compared with treatment in general ward (GWs) improves short- and long-term survival and functional outcome and increases the possibility of earlier discharge to home. The aim of the present study was to identify the differences in treatment between the SU and the GW and to assess which aspects of the SU care which were most responsible for the better outcome.Methods-Of the 220 patients included in our trial, only 206 were actually treated (SU, 102 patients; GW, 104 patients). For these patients, we identified the differences in the treatment and the consequences of the treatment. We analyzed the factors that we were able to measure and their association with the outcome, discharge to home within 6 weeks.Results-Characteristic features in our SU were teamwork, staff education, functional training, and integrated physiotherapy and nursing. Other treatment factors significantly different in the SU from the GW were shorter time to start of the systematic mobilization/training and increased use of oxygen, heparin, intravenous saline solutions, and antipyretics. Consequences of the treatment seem to be less variation in diastolic and systolic blood pressure (BP), avoiding the lowest diastolic BP, and lowering the levels of glucose and temperature in the SU group compared with the GW group. Univariate analyses showed that all these factors except the level of glucose were significantly associated with discharge to home within 6 weeks. In the final multivariate Cox regression model, shorter time to start of the mobilization/training and stabilized diastolic BP were independent factors significantly associated with discharge to home within 6 weeks.Conclusions-Shorter time to start of mobilization/training was the most important factor associated with discharge to home, followed by stabilized diastolic BP, indicating that these factors probably were important in the SU treatment. The effects of characteristic features of an SU, such as a specially trained staff, teamwork, and involvement of relatives, were not possible to measure. Such factors might be more important than those actually measured.