The Impact of a Neuro-Intensivist on Patients with Stroke Admitted to a Neurosciences Intensive Care Unit
The Impact of a Neuro-Intensivist on Patients with Stroke Admitted to a Neurosciences Intensive Care Unit
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DOI：
10.1007/s12028-008-9050-6
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发表时间：
2008-12-01
影响因子：
3.5
通讯作者：
Hacein-Bey, Lotfi
中科院分区：
文献类型：
--
作者：
Varelas, Panayiotis N.;Schultz, Lonni;Hacein-Bey, Lotfi
卒中单元可改善轻度至中度卒中患者的预后。我们试图研究全职神经强化师(NI)对在神经科学重症监护病房(NICU)住院的更严重的中风患者的预后可能起到的作用。方法前瞻性地收集了在指定NI之前和之后的两个19个月的时间内，433名中风患者在10个床位的大学医院NICU住院的数据。采用单因素和多因素分析方法，比较两个时期的脑出血、脑出血和蛛网膜下腔出血患者的预后和处置情况。观察到的死亡率在这两个时期没有不同。更多的患者在后一段时间出院(75%比前一段时间54%(P=0.003)。在调整协变量后，每种类型卒中的NICU和住院LOS在后期都较短(COX比例风险比，IS分别为2.37，1.4-4.1和1.8，1.04-3，脑出血分别为1.98，1.3-3和1.2，0.8-1.9，SAH分别为1.6，1.1-2.3和1.4，1.01-2)或所有卒中(1.92，1.52-2.43和1.7，1.28-2.25)。结论NI提供的直接病人关怀和实施的组织变革缩短了NICU和医院LOS，改善了NICU收治的中风患者的处理方式。
Introduction Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences Intensive Care Unit (NICU).Methods Data regarding 433 stroke patients admitted to a 10-bed university hospital NICU were prospectively collected in two 19-month periods, before and after the appointment of a NI. Outcomes and disposition of patients with ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were compared between the two periods, using univariate and multivariate analyses.Results One hundred and seventy-four patients with strokes were admitted in the period before and 259 in the period after the NI. Observed mortality did not differ between the two periods. More patients were discharged home in the after period (75% vs. 54% in the before period (P = 0.003). After adjusting for covariates, the NICU and hospital LOS were shorter for each type of stroke in the after period (Cox proportional hazard ratios, 95% CI were 2.37, 1.4-4.1 and 1.8, 1.04-3 for IS, 1.98, 1.3-3 and 1.2, 0.8-1.9 for ICH, and 1.6, 1.1-2.3 and 1.4, 1.01-2 for SAH, respectively) or for all strokes (1.92, 1.52-2.43 and 1.7, 1.28-2.25 for the first 12 days of hospital admission).Conclusion The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and improved the disposition of patients with strokes admitted to a NICU.