认知护理早期干预对脑卒中后抑郁和认知障碍的影响

目的观察用认知护理早期干预对脑卒中后抑郁状态和认知功能障碍的影响。方法选择脑卒中发病时间≤ 72h患者 2 0 0例 ,随机分为实验组 (10 0例 )和对照组 (10 0例 ) ,对两组患者进行健康教育并给予常规治疗护理 ,对实验组用认知护理早期干预 ,两周后对两组患者用SDS和MMSE评定。结果入组前两组脑卒中评分、日常生活能力表评分差异无意义 ;两周后实验组PSD患者SDS评分明显低于对照组 (P <0 .0 5 ) ,两组PSD患者MMSE评分差异有意义 (P <0 .0 5 )。结论对脑卒中患者早期用认知护理干预可明显改善脑卒中后抑郁状态和认知功能障碍。     

Functional recovery following rehabilitation after hemorrhagic and ischemic stroke

OBJECTIVES: To quantify recovery after rehabilitation therapy and to identify factors that predicted functional outcome in survivors of intracerebral hemorrhage (ICH) compared with cerebral infarction. DESIGN: Retrospective study of consecutive ICH and cerebral infarction admissions to a rehabilitation hospital over a 4-year period. SETTING: Free-standing urban rehabilitation hospital. PARTICIPANTS: A total of 1064 cases met the inclusion criteria (545 women, 519 men; 871 with cerebral infarction, 193 with ICH). INTERVENTIONS: Not applicable.Main Outcome Measures: Functional status was measured using the FIM trade mark instrument, recorded at admission and discharge. Recovery was quantified by the change in FIM total score (DeltaFIM total score). Outcome measures were total discharge FIM score and DeltaFIM total score. Univariate and multivariate analyses were performed. RESULTS: Total admission FIM score was higher in patients with cerebral infarction than in patients with ICH (59 vs 51, P=.0001). No difference in total discharge FIM score was present. Patients with ICH made a significantly greater recovery than those with cerebral infarction (DeltaFIM total score, 28 vs 23.3; P=.002). On multivariate analysis, younger age, longer length of stay, and admission FIM cognitive subscore independently predicted total discharge FIM and DeltaFIM total score. The severity of disability at admission, indicated by total admission FIM score, independently predicted total discharge FIM score, but not DeltaFIM total score. The ICH patients with the most severely disabling strokes had significantly greater recovery than cerebral infarction patients with stroke of similar severity. CONCLUSIONS: The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity. Initial severity of disability, age, and duration of therapy best predicted functional outcome after rehabilitation.     

Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke

OBJECTIVE: To determine the reliability, concurrent and predictive validity, and responsiveness of the Functional Ambulation Category (FAC) in hemiparetic patients after stroke. DESIGN: Prospective cohort. SETTING: An early rehabilitation center for patients with neurologic disorders. PARTICIPANTS: Fifty-five nonambulatory patients after first-ever stroke, with duration of illness between 30 and 60 days, were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FAC, Rivermead Mobility Index (RMI), walking velocity, step length, and six-minute walking test (6MWT) were assessed at the beginning, after 2 and 4 weeks of rehabilitation, and again 6 months later. After 6 months, community ambulation was also assessed. Test-retest and interrater reliability, concurrent, discriminant, and predictive validity and responsiveness of the FAC were calculated. RESULTS: Based on video examinations, high test-retest reliability (Cohen kappa=.950) and interrater reliability (kappa=.905) were found. FAC scores at the beginning and after 2 weeks, 3 weeks, and 6 months correlated highly with the RMI (Spearman rho=.686, rho=.787, rho=.825, rho=.893, respectively), distance walked in the 6MWT (rho=.949, rho=.937, rho=.931, rho=.906, respectively), walking velocity (rho=.952, rho=.939, rho=.902, rho=.901, respectively), and step length (rho=.952, rho=.932, rho=.896, rho=.877, respectively) at the same time points (all P<.001). The RMI, walking velocity, step length, and distance walked in the 6MWT differed for each FAC category (P<.001). After 4 weeks of rehabilitation, an FAC score of 4 or higher predicted community ambulation at 6 months with 100% sensitivity and 78% specificity. FAC scores changed significantly between the first 2 and second 2 weeks (Wilcoxon z=8.7, z=7.9, respectively; both P<.001) of the inpatient rehabilitation program. CONCLUSIONS: The FAC has excellent reliability, good concurrent and predictive validity, and good responsiveness in patients with hemiparesis after stroke.     

Agreement between an electrogoniometer and motion analysis system measuring angular velocity of the knee during walking after stroke

Objectives

There is a need to measure quality of movement to assess effectiveness of physical therapy interventions after stroke. Knee angular velocity may be a sensitive measure of change in performance of movement during functional activity, but not all clinical centres have access to a movement analysis laboratory. The aim of this study was to investigate the concurrent validity of using an electrogoniometer and a laboratory-based movement analysis system (Vicon Motion Systems Ltd, Oxford, UK) to measure knee angular velocity.

Design

Prospective agreement study.

Setting

Movement analysis laboratory.

Participants

Fifteen adult volunteers (mean age 55.6 years) at least 6 months after stroke and able to walk at least 4.5 m indoors.

Interventions

Kinematic data were collected simultaneously from the electrogoniometer and the Vicon system whist subjects walked forwards in the laboratory.

Main outcome measures

Electrogoniometer and Vicon data were filtered using a second-order Butterworth filter. Angular velocity was calculated for both sets of data, and the values for peak flexion and peak extension velocity for each stride were extracted for each subject trial.

Results

The intraclass correlation coefficient (ICC) and lower 95% confidence interval was 0.90 (0.87) for peak flexion angular velocity and 0.92 (0.89) for peak extension angular velocity. The limits of agreement were −50.64 to 80.28 °/second for peak flexion angular velocity and −30.59 to 86.27 °/second for peak extension angular velocity.

Conclusions

Despite high ICC values, the limits of agreement were wide. These data indicate that the Vicon system and an electrogoniometer may not be used interchangeably to measure knee angular velocity in stroke subjects.     

Estimating minimal clinically important differences of upper-extremity measures early after stroke

Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW. Estimating minimal clinically important differences of upper-extremity measures early after stroke.

Objective

To estimate minimal clinically important difference (MCID) values of several upper-extremity measures early after stroke.

Design

Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial, an acute, single-blind randomized controlled trial of constraint-induced movement therapy. Subjects were tested at the prerandomization baseline assessment (average days poststroke, 9.5d) and the first posttreatment assessment (average days poststroke, 25.9d). At each time point, the affected upper extremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upper extremity. Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests.

Setting

Inpatient rehabilitation hospital.

Participants

Fifty-two people with hemiparesis poststroke.

Interventions

Not applicable.

Main Outcome Measures

Estimated MCID values for grip strength, composite upper-extremity strength, Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and duration of upper-extremity use as measured with accelerometry.

Results

MCID values for grip strength were 5.0 and 6.2kg for the affected dominant and nondominant sides, respectively. MCID values for the ARAT were 12 and 17 points, for the WMFT function score were 1.0 and 1.2 points, and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides, respectively. MCID values were indeterminate for the dominant (composite strength), the nondominant (WMFT time score), and both affected sides (duration of use) for the other measures.

Conclusions

Our data provide some of the first estimates of MCID values for upper-extremity standardized measures early after stroke. Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke.     

Functional significance of ipsilesional motor deficits after unilateral stroke

Chestnut C, Haaland KY. Functional significance of ipsilesional motor deficits after unilateral stroke.

Objective

To determine whether ipsilesional motor skills, which have been related to independent functioning, are present chronically after unilateral stroke and are more common in people with apraxia than in those without apraxia.

Design

Observational cohort comparing the performance of an able-bodied control group, stroke patients with left- or right-hemisphere damage matched for lesion volume, and left-hemisphere stroke patients with and without ideomotor limb apraxia.

Setting

Primary care Veterans Affairs and private medical center.

Participants

Volunteer right-handed sample; stroke patients with left- or right-hemisphere damage about 4 years poststroke; a control group of demographically matched, able-bodied adults.

Interventions

Not applicable.

Main Outcome Measures

Total time to perform the (1) Williams doors test and the (2) timed manual performance test (TMPT), which includes parts of the Jebsen-Taylor Hand Function Test.

Results

Ipsilesional motor deficits were present after left- or right-hemisphere stroke when using both measures, but deficits were consistently more common in patients with limb apraxia only for the TMPT.

Conclusions

These findings add to a growing literature that suggests that ipsilesional motor deficits may have a functional impact in unilateral stroke patients, especially in patients with ideomotor limb apraxia.     

抗阻力训练联合计算机化认知训练治疗脑卒中后轻度认知障碍的疗效分析

目的：探讨抗阻力训练联合计算机化认知训练（CCT）治疗脑卒中后轻度认知障碍的疗效。方法：116例脑卒中后轻度认知障碍患者,随机分为2组各58例。对照组采用CCT训练,观察组采用抗阻力训练联合CCT训练。比较2组认知功能、注意和执行功能、记忆功能、生活能力、血清脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）的差异。结果：训练8周后,2组MMSE评分、MoCA评分、RBMT评分、BI指数、血清BDNF、NSE水平均较训练前增高（均P＜0.05）,且观察组高于对照组（P＜0.05）;2组完成数字卡片排序时间均较训练前缩短（均P＜0.05）,且观察组低于对照组（P＜0.05）;2组血清CRP、IL-6、IL-1β水平均较训练前降低（均P＜0.05）,且观察组低于对照组（P＜0.05）。结论：抗阻力训练联合CCT治疗可更有效地降低脑卒中后轻度认知障碍患者血清炎症因子水平,增加血清神经因子水平,改善认知、注意和执行、记忆功能,提高生活能力。     

Measuring upper limb capacity in patients after stroke: reliability and validity of the stroke upper limb capacity scale

Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the Stroke Upper Limb Capacity Scale.

Objective

To investigate the interrater reliability and construct validity of the Stroke Upper Limb Capacity Scale (SULCS).

Design

Cohort study.

Setting

Inpatient department of a rehabilitation center.

Participants

Patients after stroke (N=21; mean age ± SD, 61.7±7.9y; 57% men), undergoing inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

The SULCS was administered by occupational therapists (OTs) within 6 weeks after stroke (t1), 3 months after t1 by the same OT (t2), and within 1 week after t2 by another OT (t3). Interrater reliability, the repeatability between different raters, was assessed by calculating the intraclass correlation coefficient (ICC) based on the scores at t2 and t3. Construct validity, indicating agreement with hypotheses concerning the construct that is being measured, was assessed with Spearman rank correlation coefficient (ρ). The SULCS scores were cross-sectionally correlated with those of the Action Research Arm Test (ARAT) and the Rivermead Motor Assessment (RMA) at t1, and longitudinally with the respective change scores between t1 and t2.

Results

The SULCS (range, 0–10) had a high ICC (.94; 95% confidence interval, .86–.97) and strong cross-sectional correlation with both the ARAT and the RMA (ρ=.91 and ρ=.85, respectively), while the respective change scores showed a strong correlation with the ARAT (ρ=.71) and a moderate correlation with the RMA (ρ=.48).

Conclusions

The SULCS has good interrater reliability and construct validity.     

Functional and occupational characteristics associated with very early return to work after stroke in Japan

Tanaka H, Toyonaga T, Hashimoto H. Functional and occupational characteristics associated with very early return to work after stroke in Japan.

Objectives

To examine clinical, functional, and occupational factors associated with very early return to work after stroke, and to identify factors manageable through occupational arrangements, patient education, and other welfare programs.

Design

Prospective cohort study.

Setting

Acute care of the first stroke event in 21 acute care hospitals specializing in clinical and occupational health.

Participants

Consecutive patients with stroke in working age (N=335).

Interventions

Not applicable.

Main Outcome Measures

Data pertaining to demographic, clinical, functional, and occupational factors were collected from hospital records. Multiple logistic regression analysis with backward stepwise selection was used to obtain a final model to predict the likelihood of patients returning very early to work.

Results

The sample was predominantly men (80%) with a mean age ± SD of 55.2±7.2 years; 30% succeeded in very early return to work. After adjusting for age, sex, and modified Rankin scale at discharge, white-collar versus blue-collar occupation (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.00–4.21), Barthel Index at onset (OR, 1.02; 95% CI, 1.01–1.03), and employment status at discharge (OR, 17.36; 95% CI, 3.15–95.72) were selected in the final model as significant predictors of very early return to work. Patients with mild physical disability and higher cortical dysfunction found it more difficult to return to work very early compared with those without these conditions.

Conclusions

We found that patients with stroke who had mild disability at onset, were in a white collar occupation, and were employed at discharge were more likely to return to work very early, even after adjusting for functional levels at discharge. Cognitive rehabilitation is needed for those with mild physical disability and higher cortical dysfunction.     

Life experiences after stroke among Iranian stroke survivors

DALVANDI A., HEIKKILÄ K., MADDAH S.S.B., KHANKEH H.R. & EKMAN S.L. (2010) Life experiences after stroke among Iranian stroke survivors. International Nursing Review 57 , 247–253 Background: Stroke is a major cause of disability worldwide. It is a life‐threatening and life‐altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long‐term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. Aim: To illuminate how stroke survivors experience and perceive life after stroke. Method: A grounded theory approach was recruited using semi‐structured interviews with 10 stroke survivors. Findings: The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio‐economical situation and life disintegration. The core concept of life after stroke was functional disturbances. Conclusions: The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.     

认知训练及体位干预对脑卒中后认知障碍及偏瘫患者的运动功能影响观察

目的探讨认知训练及体位干预对脑卒中后认知障碍及偏瘫患者运动功能的影响。方法选取某院2017年9月至2018年9月康复科及神经科住院的初发脑卒中患者120例为观察对象,按随机数表法分为观察组和对照组各60例。两组患者均实行常规康复治疗和护理,观察组在对照组的基础上,增加认知训练及体位干预,治疗时间6个月。观察比较两组患者改良式肢体运动功能量表(Fugl-Meyer)、功能综合评定量表(FCA)、日常生活活动量表Barthel指数(BI)和简易精神状态量表(MMSE)评分情况。结果干预6个月后,观察组患者Fugl-Meyer、FCA、BI评分分别为(46.37±9.16)分、(75.43±10.28)分、(58.62±10.27)分显著高于对照组的(36.32±8.15)分、(66.89±9.04)分、(52.65±9.16)分(P<0.05),且观察组MMSE评分为(20.36±2.87)分显著高于对照组的(17.69±3.69)分(P<0.05)。结论对于认知障碍伴偏瘫的脑卒中后患者,加强认知训练及体位干预,对其提高认知功能、运动功能及日常生活活动能力均有重要意义。     

Sexuality after stroke: Exploring knowledge,attitudes, comfort and behaviours of rehabilitation professionals

BackgroundSexual dysfunction after stroke is common and is associated with poor health and quality of life outcomes. Clinical guidelines for stroke typically recommend that all stroke survivors have access to support relating to sexuality during rehabilitation. However, the extent to which rehabilitation professionals are prepared to address sexuality after stroke is unclear.ObjectiveTo investigate the knowledge, comfort, approach, attitudes, and practices of rehabilitation professionals toward supporting stroke survivors with their sexuality concerns.MethodsCross-sectional analytic survey design. Data were collected by using an electronic questionnaire that contained the Knowledge, Comfort, Approaches, and Attitudes towards Sexuality Scale (KCAASS) and sexuality-related practice questions. Participants were recruited from Australia, New Zealand, the United States, Canada, United Kingdom, Ireland, Singapore, and South Africa. Multiple regression was used to explore KCAASS scores and sexuality-related practices.ResultsA total of 958 multi-disciplinary, stroke rehabilitation professionals participated in the study. Only 23% (n = 216) of health professionals’ reported directly initiating sexuality discussions with stroke survivors. On regression analysis, professionals’ practices, perception of their role in sexuality rehabilitation, sexuality training, education, age and sex predicted their knowledge of sexuality after stroke (r² = 0.44; p < 0.001). Sexuality training, religious affiliation and provision of sexuality-rehabilitation services predicted comfort (r² = 0.21; p < 0.001). Professionals’ age and provision of sexuality-rehabilitation services predicted approach-related comfort (r² = 0.2; p < 0.001). Professionals’ perception of health professionals’ role in sexuality rehabilitation, religious affiliation and geographical location predicted professionals’ attitudes toward sexuality (r² = 0.11; p < 0.001). Open-ended responses indicated that participants perceived a need to improve their competency in providing sexuality rehabilitation. The timing of training predicted knowledge (t = 3.99; p < 0.001), comfort (t = 3.47; p < 0.001) and the provision of sexuality-rehabilitation services (t = 3.68; p < 0.001).ConclusionFindings confirm that sexuality is neglected in stroke rehabilitation and point to the need for a considered approach to the timing and nature of education.     

急性脑卒中后并发血管性认知障碍患者的血清半胱氨酸蛋白酶抑制剂C水平变化

目的 探讨急性脑卒中后并发血管性认知障碍(VCI)患者的血清半胱氨酸蛋白酶抑制剂(Cys)C水平的变化及其临床意义,为VCI患者的早期诊断及治疗提供依据.方法 选择2012年12月至2013年12月东营市人民医院神经内科和神经外科收治的120例急性脑卒中患者为研究对象,纳入研究组,按脑卒中后是否并发VCI将其分为VCI亚组(n=60)和非VCI亚组(n=60);并选择同期于本院门诊体检的年龄≥50岁、无认知功能减退主诉的60例受试者纳入对照组.采用《简易精神状态评价量表》(MMSE)系统评价VCI亚组患者认知功能,并根据MMSE评分结果评价其VCI严重程度.采用全自动生化分析仪免疫比浊法检测研究组与对照组血清Cys C水平,并进行比较,同时对VCI亚组患者血清Cys C水平与VCI严重程度之间的关系进行统计学分析.本研究遵循的程序符合东营市人民医院人体试验委员会所制定的伦理学标准,得到该伦理会批准,分组征得受试对象本人的知情同意,并与之签订临床研究知情同意书.结果 VCI亚组、非VCI亚组及对照组3组受试者性别构成、年龄、受教育年限、原发性高血压、糖尿病等社会人口学资料比较,差异均无统计学意义(P＞0.05).VCI亚组患者血清Cys C水平为(1.68±0.46) mg/L,高于非VCI亚组[(0.88±0.42) mg/L]和对照组[(0.83±0.32) mg/L],且3者比较,差异有统计学意义(F=12.99,P＜0.05).VCI亚组患者中,VCI不同严重程度患者血清Cys C水平比较,差异有统计学意义(F=7.98,P＜0.05).其中,MMSE评分≤13分的重度VCI患者为19例,其血清Cys C水平最高,为(1.92±0.36) mg/L;MMSE评分为≥14～20分的中度VCI患者为23例,其血清Cys C水平为(1.33±0.41) mg/L;MMSE评分为≥21～24分的轻度VCI患者为18例,其血清Cys C水平最低,为(1.09±0.28) mg/L.3者比较,差异有统计意义(F=7.98,P＜0.05).VCI亚组患者血清Cys C水平越高,其VCI程度越严重.VCI亚组患者Cys C水平与MMSE评分的Spearmen相关系数的双变量相关分析结果示,MMSE评分与VCI患者血清CysC水平呈负相关关系(r=-0.421,P=0.039).结论 急性脑卒中患者血清Cys C水平与其VCI的发生、发展有关.血清Cys C水平可作为急性脑卒中患者VCI早期诊断的外周血生物学标志物之一,为VCI的早期诊断与治疗提供生物学依据.     

Subjective memory impairment after stroke

The responses of 95 stroke patients and 129 orthopaedic control patients were compared on a questionnaire of subjective memory abilities. Stroke patients reported more problems than orthopaedic controls, and relatives observed more problems in both groups than were reported by patients. Reassessment after 6 months showed that stroke patients rated their memories as worse but their relatives observed an improvement. Factors such as whether the patient was in hospital or at home, and the side of the lesion, were not found to be related to overall subjective memory impairment.     

Racial disparities in outcomes of inpatient stroke rehabilitation

OBJECTIVE: To determine whether race is associated with outcomes of inpatient stroke rehabilitation. DESIGN: Retrospective cohort study. SETTING: A community-based inpatient rehabilitation facility. PARTICIPANTS: Poststroke patients (N=1002) admitted to a community-based inpatient rehabilitation facility between 1995 and 2001. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional improvement at discharge from the rehabilitation facility, discharge disposition, and functional improvement at 3 months after discharge. Inpatient and follow-up data were collected from the facility's electronic patient database. We used the FIM instrument to assess functional status at admission, discharge, and follow-up. RESULTS: In multivariable models, blacks achieved less functional improvement at discharge (-1.9 FIM points, P=.02) compared with whites and, despite worse FIM scores, were more likely to be discharged to home (adjusted odds ratio=1.7; 95% confidence interval, 1.1-2.5). Although Asian-American patients did not differ from whites in terms of functional improvement at discharge or disposition, they had less improvement at 3 months following discharge (-6.3 FIM points, P=.005). CONCLUSIONS: We identified racial disparities in poststroke outcomes in a community-based inpatient rehabilitation facility. Future research in stroke rehabilitation should explore the consistency of these findings across settings and if they are confirmed, identify explanatory mediators to better inform efforts to eliminate racial disparities.     

Relationship between executive functions and productivity outcomes following stroke

Purpose. Stroke occurs in many individuals of working age and can considerably disrupt their capacity for employment and other productive activities. Few studies have examined the relationship between loss of productivity and cognitive impairment, particularly deficits in executive function. The present study examined whether performance on tests of executive function is related to employment and productivity at 12-months follow-up.

Method. Twenty-seven individuals (mean age = 47.3 years, SD = 10.7) on average 2.1 years (SD = 1.6) post-stroke were recruited from hospital and community rehabilitation services and administered a theory-driven battery of executive function tests (i.e. Health and Safety sub-test, FAS Test, Five-Point test, Key Search Test and Tinkertoy Test). A 12-month follow-up assessment of employment outcome (‘employed’ or ‘unemployed’) and productivity (measured by the Sydney Psychosocial Reintegration Scale) was conducted.

Results. A series of between-group comparisons identified that a measure of purposive behaviour and self-regulation (i.e. the Tinkertoy Test) best distinguished between the employed and unemployed groups (p < 0.01) irrespective of time since injury and neglect. Level of post-stroke productivity was significantly correlated with measures of planning (p < 0.05), self-monitoring (p < 0.01) and self-regulation (p < 0.05), as well as time since injury (p < 0.05) and functional status (p < 0.01).

Conclusions. These findings highlight the importance of routinely assessing executive functions to guide cognitive rehabilitation interventions following stroke.     

脑卒中患者的结构功能障碍

用目前国外较常用的一种结构功能障碍的评测方法,对50例脑卒中患者和50例正常人进行评测。其结果表明:脑卒中患者结构功能障碍的发生率较高(54％),结构功能障碍的发生率在顶枕叶和额叶病变的脑卒中患者之间差异无显著性,而与病变发生于哪一侧大脑半球有关,右侧顶枕叶是结构功能障碍患者的主要病变部位;结构功能障碍的发生率及程度明显受患者年龄和文化程度的影响。     

Epidemiologic features,risk factors,and outcome of sepsis in stroke patients treated on a neurologic intensive care unit

Purpose

Because of the immune-suppressive effect of cerebral damage, stroke patients are at high risk for infections. These might result in sepsis, which is the major contributor to intensive care unit (ICU) mortality. Although there are numerous studies on infections in stroke patients, the role of sepsis as a poststroke complication is unknown.

Methods

We retrospectively analyzed incidence of and risk factors for sepsis acquisition as well as outcome parameters of 238 patients with ischemic or hemorrhagic strokes consecutively admitted to the neurologic ICU in a tertiary university hospital between January 1, 2009, and December 31, 2010. Basic demographic and clinical data including microbiological parameters as well as factors describing stroke severity (eg, lesion volume and National Institute of Health stroke scale score) were recorded and included into the analysis. The diagnosis of sepsis was based on the criteria of the German Sepsis Society.

Results

We identified 30 patients (12.6%) with sepsis within the first 7 days from stroke onset. The lungs were the most frequent source of infection (93.3%), and gram-positive organisms were dominating the microbiologic spectrum (52.4%). Comorbidities (chronic obstructive pulmonary disease and immunosuppressive disorders) and Simplified Acute Physiology Score II but none of the factors describing stroke severity were independent predictors of sepsis acquisition. Sepsis was associated with a significantly worse prognosis, leading to a 2-fold increased mortality rate during in-hospital care (36.7% vs 18.8%) and after 3 months (56.5% vs 28.5%), but only in the subgroup of supratentorial hemorrhages, it was an independent predictor of in-hospital and 3-month mortality. Other factors significantly associated with death in a multivariate analysis were chronic obstructive pulmonary disease, malignancies (in-hospital mortality only), and Simplified Acute Physiology Score II (3-month mortality only) for ischemia and heart failure (in-hospital mortality only), National Institute of Health stroke scale score (in-hospital mortality only), and stroke volume for hemorrhages, respectively.

Conclusions

Sepsis seems to be a frequent complication of stroke patients requiring neurologic ICU treatment. Predictors of sepsis acquisition in our study were comorbidities and severity of deterioration of physiological status, but not stroke severity. A better understanding of risk factors is important for prevention and early recognition, whereas knowledge of outcome may help in prognosis prediction. Further studies are needed to clarify the optimal preventive treatment for these patients.