ICU脑卒中复康干预的针对措施和短期结局

目的：探讨重症脑卒中的干预措施和近期目标，以及重症和早期康 医疗的临床意义。方法；对患者进行临床评定，包括主要病情、监护指标、心功能、Glasgow昏迷量表（GCS）、简式Fugl-Mayer评估（FMA）等，对康复干预可能引起的反应和产生影响的监护指标进行观测。针对不同监护下状态采用适当康复干预措施。结果：在本组中风ICU的主要合并症和并发症中，肺部感染占73．52％；心脏疾患占38．24％；糖尿病占26．47％。虽然在康复干预后患者的运动功能仍然较低，但治疗组患者在实施康复治疗后GCS评分明显提高（P＜0．001），而对照组改善不明显。治疗组FMA和对照组FMA在治疗后都有明显提高，而治疗组上下肢运动功能改善优于对照组（P＜0．05）。结论：ICU6脑卒中患者有神经系统和心肺等方面的复杂问题，应采取针对性的对策，从其由ICU转归普通病房时的功能状况来看其结局是有利于重症患者的。     

再次急性心肌梗死的不同时间窗rt—PA溶栓疗效对比研究

目的：探讨再次急性心肌梗死患者不同时间窗rt—PA溶栓的临床疗效。方法：51例入选患者根据再发心肌梗死到接受溶栓治疗的时间分为两组，A组28例为1—3小时；B组23例为3—6小时。两组均给予静脉内100mg rt—PA溶栓辅予相同的常规治疗。结果：A组再通率78．6％，B组再通率65．2％，A组临床症状改善和冠脉再通率与B组有显著差异（P〈0．05），2周内LEVF亦有显著差异（P〈0．05），并发症明显减少。结论：静脉内rt—PA溶栓治疗对再次急性心肌梗死患者仍有较好疗效，溶栓越早疗效越好。     

多中心ICU护士对重症患者早期康复认知的现状及影响因素研究

目的：基于多中心调查ICU护士对重症患者早期康复认知的现状并分析其影响因素。方法：采用便利抽样，在2022年11月至12月对天津市18所三级综合医院符合要求的ICU护士进行调查，采用一般资料调查表、ICU护士对重症患者早期康复认知问卷调查ICU护士对重症患者早期康复理论知识的认知程度以及康复技术实践能力，并探讨ICU护士对重症患者早期康复认知的影响因素。结果：ICU护士对重症患者早期康复整体认知得分为（3.86±0.63）分，其中康复理论知识、康复技术实践能力得分分别为（3.98±0.62）分、（3.76±0.72）分。多元线性回归显示，工作岗位、是否接受过早期康复相关的培训、科室内是否有早期康复方案、科室内是否有康复专职护士是ICU护士对重症患者早期康复认知的独立影响因素。结论：ICU护士对重症患者早期康复的整体认知处于中等水平，应进一步加强重症康复相关培训，提高康复技术临床实践能力，构建标准化实践方案，推动重症康复持续发展。     

急性脑卒中患者早期康复的临床研究

目的：探讨早期康复治疗对急性脑卒中患者的重要性,安全性,有效性,以及康复治疗介入时间与疗效的关系。方法：选择急性脑卒中患者60例,按康复介入时间不同分为A组（病后7d之内开始康复）,B组（病后7－30d开始康复）,全部患者生命体征平衡,神经学症状48h内不再发展,意识评分Glasgow&;gt;8,按早期康复程序进行康复训练。结果：经1个月的康复治疗后,两组运动功能,平衡功能,临床神经功能缺损评分均无显著性差异。结论：早期康复治疗能减少患者的“误用”和“废用”综合征,提高运动功能,对于大部分患者来讲,如在1个月内开始康复,其疗效无统计学差异。     

脑卒中偏瘫早期康复疗效观察

目的探讨早期基本康复训练对脑卒中患者运动功能、平衡功能、日常生活活动（ＡＤＬ）和继发性残疾的影响。方法对２００例脑卒中偏瘫患者以抽签方式随机分为康复组（１００例），对照组（１００例）。对康复组进行了早期康复研究，平均于病后９天开始，应用简单的康复医疗程序，进行床边治疗。结果平均３５天治疗后，取得明显疗效：①运动功能达ＢｒｕｎｎｓｔｒｏｍⅣ级以上者，上肢４９％、手４４％，下肢７５％。步行恢复率达６３％；②坐位平衡功能达Ⅱ级和Ⅲ级者占８３％，站位平衡占５０％；③日常生活活动积分在６０分以上、恢复良好者达５４．３％；④预防及减少了继发性残疾。与对照组相比存有显著差异（Ｐ＜０．０００５）。结论以简单的康复医疗程序进行脑卒中早期康复有效可行     

脑卒中急性期康复护理及康复训练的程序及特征

目的：为使脑卒中患者最大限度地恢复受损的神经功能，回归社会，提高生活质量，制定急性期早期规范的康复程序。方法：康复程序包括康复治疗、康复护理、体位处理、主动运动、被动运动、日常生活活动训练和失禁处理。结果：急性期的早期康复能使脑卒中患者受损的神经功能最大限度地得到恢复，并发症减少。结论：脑卒中患者早期康复有助于受损神经神经功能的恢复。     

急性脑卒中偏瘫患者早期康复的护理

目的：探讨急性脑卒中偏瘫患者早期康复护理的意义。方法：将现代康复的理念与早期临床护理相结合，对186例脑卒中患者入院6周内实施心理护理和康复措施。结果：早期介入康复护理，取得了较好的疗效。结论：急性脑卒中偏瘫患者给予早期康复护理对提高患者的活动能力和降低并发症和致残率有肯定效果。     

急性脑卒中患者早期康复对肢体运动功能恢复70例体会

为探讨早期康复治疗对急性脑卒中患者息肢功能恢复的作用，对70例急性脑卒中患者进行早期康复治疗，方法为病情稳定即接受训练，包括运动意念训练和被动运动相结合的方法。结果提示早期康复治疗能有效促进患肢功能恢复，提高生活质量。     

急性脑卒中患者早期康复的临床研究

目的探讨早期康复治疗对急性脑卒中患者的重要性、安全性、有效性,以及康复治疗介入时间与疗效的关系。方法选择急性脑卒中患者60例,按康复介入时间不同分为A组（病后7d之内开始康复）、B组（病后7～30d开始康复）。全部患者生命体征平稳,神经学症状48h内不再发展,意识评分Glasgow>8,按早期康复程序进行康复训练。结果经1个月的康复治疗后,两组运动功能、平衡功能、临床神经功能缺损评分均无显著性差异。结论早期康复治疗能减少患者的“误用”和“废用”综合征,提高运动功能。对于大部分患者来讲,如在1个月内开始康复,其疗效无统计学差异。     

脑卒中患者开始康复时间和康复持续时间与运动功能的恢复

目的：探讨脑卒中患者开始康复介入时间和持续时间对运动功能恢复的影响。方法：选择1993-01／2000-12黑龙江省康复医院康复科住院脑卒中患者423例，将发病至开始康复时间分为0d～组(0-29d，n=196)、30d～组(30-89d，n=150)和90～180d组(90-180d，n=77)采用Bobath，Brunnstrnm．多感觉刺激疗法、本体感觉型神经肌肉促通术、心理康复，由专业治疗师与患者“一对一”地进行训练，45min／次，1次/d入院7d内按Brunnstrom 6级标准、手功能砰定的5个动作、步行能力4级标准和日常生活活动能力的Barthel指数初评，以后每个月评测1次，连续进行3个月。结果：按实际完成处理，有423例患者纳入结果分析运动功能恢复总有效率0d～组79．1％(155／196)；30d～组47．3％(7l／l50)；90～180d组26．0％(20／77)，与前两组比较差异均有显著性(X^2=37．807．9,665．P=0．000，0．002)0d～组和30d～组患行按不同的康复治疗持续时间(1个月、2个月和3个月)分别对运动功能恢复的总有效率进行组内对比，结果为持续时间3个月(0d～组：962％，78／81；30d～组：67，6％，25/37)比2个月(0d～组：78，8％，52／66；30d～组：47．8％，32／67)效果明显：2个月比1个月(0d～组：51．0％，15／49；30d～组：282％，13／46)效果明显(X^2=3.775～10．90l，P均&;lt;0．05)结论：脑卒中患者开始康复介入时间越早，即能够接受康复或治疗性结束一开始即实施早期康复干预，其运动功能的恢复效果越好；往康复持续时间上，结果显示，发病后1个月内开始康复的3个水平中，以持续3个月效果最好；发病后1～3个月开始康复患行亦显示出持续康复时间越长，效果越显著；发病3个月后才开始康复患者虽然持续康复时间越长，总有效率有所增加，但不同的康复持续时间对疗效的影响在统计学上无明显差异。     

早期康复对手足口病并发急性迟缓性瘫痪的影响

目的观察早期康复对手足口病并发急性迟缓性瘫痪的治疗效果。方法2009 年8 月～2010 年12 月山西省儿童医院隔离科手足口病并发急性迟缓性瘫痪患儿31 例。其中21 例为治疗组,病后2 周开始早期康复治疗。10 例为对照组,均因家长拒绝康复干预或放弃治疗。观察期为4 个月。结果治疗组临床痊愈20 例,明显好转1 例;对照组好转1 例,无效9 例。结论早期康复有利于手足口病并发急性迟缓性瘫痪患儿的肢体功能恢复。     

Early unplanned transfers from inpatient rehabilitation

OBJECTIVE: To identify characteristics of patients who transfer off inpatient rehabilitation to a surgical or medical unit before completion of their rehabilitation program. DESIGN: A retrospective 9-yr chart review of patients transferred off the rehabilitation unit at a regional level 1 trauma center due to medical complications. RESULTS: Of 3072 patient admissions, 250 (8%) were transferred to an acute medical or surgical unit, and 55 (22%) of those transfers were within 3 days. Of the 250 patients, 33% had traumatic brain injury, 23% had spinal cord injury, 24% had stroke, 2% had amputations, 18% were in other diagnostic groups, and 23% were >64 yrs of age. When patients transferred early, only 47% were ultimately discharged to home, compared with approximately 72% of all discharges. The most common reasons for early transfer in these patients were infection (22%) and pulmonary complications (14%). Risk factors for early discharge included age of >64 yrs, spinal cord injury, or amputation. CONCLUSION: Patients admitted to the inpatient rehabilitation unit who have spinal cord injuries, amputations, or are >64 yrs old may have more medical/surgical complications. More detailed study of this patient population may help reduce the number of early transfers off the inpatient rehabilitation unit.     

Early smooth horizontal eye movement: a favorable prognostic sign in patients with locked-in syndrome

Locked-in Syndrome (LIS) is a rare clinical entity consisting of quadriplegia, paralysis of lower cranial nerves, mutism, and bilateral paresis of horizontal gaze. The prognosis is usually poor. Most patients who do survive have severe residual impairment or develop chronic LIS. Review of the literature shows that recovery has been reported but not systematically studied, particularly with respect to early prognostic signs. We report a case of LIS with bilateral pontine infarctions shown by MRI. Severe neurological deficits included quadriplegia, paresis of horizontal gaze, facial paralysis, and bulbar palsy. Horizontal eye movements were present and smooth by the second week after onset. The patient had almost full functional motor recovery within four months, after a comprehensive rehabilitation program. Fourteen other reported cases of LIS with full recovery had documented recovery of lateral gaze in the early stage. In addition, smooth horizontal gaze is the most frequent activity in incomplete LIS. Early recovery of horizontal eye movement may indicate that the brain lesion is limited and may be a good prognostic sign in LIS.     

Acute flaccid paralysis associated with West Nile virus: motor and functional improvement in 4 patients

OBJECTIVE: To describe motor and functional recovery in 4 patients with acute flaccid paralysis associated with West Nile virus (WNV) infection. DESIGN: A case series describing patient clinical features at admission to rehabilitation through 6-month follow-up. SETTING: Academic acute free-standing inpatient rehabilitation hospital. PARTICIPANTS: The patients (3 men, 1 woman; age range, 29-72 y) with central nervous system WNV infection presented on rehabilitation admission, 18 to 112 days after onset of symptoms, with severe flaccid asymmetric weakness without sensory loss, and decreased functional independence. Electrodiagnostic studies demonstrated a severe diffuse motor axonopathy consistent with an anterior myelitis. INTERVENTION: Acute inpatient rehabilitation program over a period of 35 to 106 days. MAIN OUTCOME MEASURES: Motor and FIM instrument scores at admission to rehabilitation, discharge, and 6-month follow-up. RESULTS: All patients showed modest improvements in strength and function; no patient made full recovery of strength or became ambulatory by 6-month follow-up. CONCLUSIONS: Little is known about recovery in patients with WNV-associated anterior myelitis. It will be important to document any further improvements in strength and function in such patients over a longer follow-up period.     

早期康复治疗对急性脑卒中患者生存质量的影响

目的:探讨早期康复治疗对脑卒中患者6个月后生存质量的影响。方法:80例脑卒中偏瘫患者随机分为康复组(40例)和对照组(40例)进行临床对照研究,两组均常规进行神经内科药物治疗,康复组加以运动疗法和言语治疗,并对每组患者在入组时和6个月后利用生存质量评定量表简表(WHOQOL-BREF)中文版对其生存质量(Qualityoflife,QOL)进行评定。结果:康复组两次生存质量评分分别为59.85±12.14、76.66±13.62,对照组为59.87±11.45、69.75±10.19;两组前后比较均有显著性差异(P<0.05);两组变化均数比较,康复组6个月后的QOL恢复优于对照组(P<0.05)。结论:早期康复治疗可以提高急性脑卒中患者的生存质量。     

180例急性重型颅脑损伤患者的早期康复治疗

目的 观察急性重型颅脑损伤急性期康复对预防并发症的作用。方法 对180例急性重型颅脑损伤患者进行急性期康复治疗，方法包括呼吸康复、全关节活动范围内的被动活动、定时翻身、预防尿路感染、中医针灸、按摩等，促进瘫痪肢体神经功能的恢复。结果 180例患者住院治疗期间有15例出现肺部并发症，发生率为8．3％，无1例死于并发症。结论 早期康复治疗可有效预防并发症，提高治疗效果。     

Early and long-term outcome of rehabilitation in stroke patients: the role of patient characteristics,time of initiation,and duration of interventions

OBJECTIVE: To determine whether and how patient characteristics and the time of initiation and duration of rehabilitation influence early and long-term patient outcome after cerebrovascular accident. DESIGN: A cohort study. SETTING: Twenty rehabilitation hospitals and wards located throughout Italy. PARTICIPANTS: A total of 1716 stroke patients (874 men, 842 women) consecutively admitted to Italian hospital rehabilitation centers in 1997 and 1998. Patients had moderate to severe disability (FIM instrument score, < or =90). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three negative patient outcomes were considered: death, early failure (premature, unwanted interruption of rehabilitation program; absence of any improvement at hospital discharge), and late failure in terms of severe disability (Barthel Index score, <40) or poor quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey; questionnaire score, <80) 6 months after admission. The strength of the association between the considered variables and the outcomes was calculated with the odds ratio (OR). RESULTS: The less disabled and younger patients had better survival and early and long-term outcomes. The presence of dementia and pressure ulcers on admission was associated with worse outcomes (OR for any failure or death=1.31; 95% confidence interval [CI], 1.03-1.67; OR=1.63; 95% CI, 1.12-2.37, respectively). Patients who initiated the rehabilitative procedures early (within 7d after stroke) had better long-term outcomes than did those who initiated the rehabilitation after more than 1 month (OR=2.12; 95% CI, 1.35-3.34) or from 15 to 30 days after the acute cerebrovascular event (OR=2.11; 95% CI, 1.37-3.26). CONCLUSIONS: This study's results support the idea that recovery after stroke is greatly influenced by the clinical and demographic characteristics of the patients and that early rehabilitation intervention may have a relevant role.     

急性驰缓性瘫痪儿童早期床旁康复治疗对运动功能的影响

目的 探讨早期床旁康复治疗对急性驰缓性瘫痪(AFP)患儿肢体运动功能的影响.方法 AFP患儿45例分为两组:治疗组23例在生命体征平稳,神经系统症状停止进展即进行床旁康复治疗;对照组22例在急性期后进行康复治疗.结果治疗组在治疗后2周、4周的肌力恢复优于对照组(P＜0.05).结论 早期床旁康复治疗对AFP患儿近期运动功能恢复效果明显.     

Demographics and clinical outcomes of patients admitted to a respiratory intensive care unit located in a rehabilitation center

INTRODUCTION: A recent survey of respiratory intensive care units (RICU) in Italy showed that RICUs in Italy are mainly (85%) located in acute care hospitals. Forty-seven percent of the patients are admitted from emergency departments, and only 18% are admitted from intensive care units (ICU), so the percentage of patients admitted for difficulty in weaning is low (8%). Patient demographics and admission patterns in RICUs located outside acute care hospitals have not been previously described. METHODS: We analyzed admission patterns, demographics, treatment, and outcomes of patients during the first year of operation of a 7-bed RICU located in a rehabilitation center that does not have an emergency department. RESULTS: In the 1-year study period, 96 RICU patients were admitted for acute or chronic respiratory failure. The patients' mean Simplified Acute Physiology Score II was 28.9 +/- 3.6. Sixty-five percent of the patients were transferred from the ICU, 17% from medical wards of other hospitals, 7% and 5%, respectively, from the medical and surgical wards of our hospital, and 6% came directly from home for a periodic check. Difficulty in weaning from mechanical ventilation was the main reason for admission (42%), followed by simple monitoring (37%) and need for acute ventilatory invasive or noninvasive support (21%). Thirty-one patients had COPD, 23 had acute hypoxemic respiratory failure, 30 had post-surgical complications, and 12 had neuromuscular disease. Twenty-seven of 40 patients admitted for difficulty in weaning were liberated from ventilation. Intrahospital mortality was 13%. Fifty percent of patients were discharged directly to home; those patients' mean Dependence Nursing Scale score (which measures the degree of patient independence) improved during hospital stay (decreased from 23 to 12 [p < 0.05]), whereas the remaining patients were transferred to long-term facilities or an acute care hospital. CONCLUSIONS: The admission pattern at our RICU in a rehabilitation center is quite different from that of an RICU in an acute care hospital. Most of our patients are admitted from ICU because of difficulty with weaning. This may be the consequence of the institutional philosophy of rehabilitation centers, which strive to achieve greater patient independence.