Effect of Comorbidity on Functional Recovery in Patients with Stroke

腦中風病患共病症與功能恢復之影響

邱國琄(Kuo-chuan Chiu) ； 林佩欣(Pei-Hsin Lin) ； 林語蓁(Serena Y.C Lin) ； 高木榮(Mu-Jung Kao)

《台灣復健醫學雜誌》 46卷1期 (2018/06) Pp. 27-35

https://doi.org/10.6315/TJPMR.201806-46(1).04

摘要

Objectives: Stroke is a vital cause of acute neurological dysfunction. This study evaluated the prevalence of comorbidities and their effects on functional recovery in patients with stroke. Methods: This was a prospective study. The participants were 105 patients with acute stroke with moderate to severe functional disability who were admitted for comprehensive rehabilitation. The participants were 76 patients who underwent the Post-acute Care-Cerebrovascular Diseases program and 29 participants who accepted a regular rehabilitation program within 6 months after stroke. The effect of each comorbidity on the patients' post-hospitalization daily living activities was analyzed based on the Charlson Comorbidity Index (CCI). Results: For each 1-point increase in a patient's CCI score, there was a 0.97-point decrease in the patient's score on the Barthel Index (BI) after discharge (p = 0.013). An analysis of 19 comorbidities showed that the order of highest prevalence was diabetes (21%), prior cerebrovascular accident with mild or no residual or transient ischemic attack (17.1%), and diabetes with end-organ damage (14.3%). An analysis of the effect of the various comorbidities on the patients' daily living activities indicated that the most harmful disease was chronic pulmonary disease (leading to a decrease of discharge BI scores by 35.50 points; p = 0.004), followed by prior history of hemiplegia (leading to a decrease of discharge BI scores by 18.51 points; p = 0.002). Conclusions: Comorbidities, especially chronic pulmonary disease and hemiplegia, can affect the functional recovery and daily living activities of patients with stroke. Other comorbidities, including osteoarthritis and arrhythmia, need to be investigated. A comorbidity index should be established for patients with stroke.

關鍵字

acute cerebrovascular disease ； comorbidity ； functional recovery

並列摘要

目的：腦中風是導致急性神經功能障礙的重要原因，本研究探討腦中風患者共病症盛行率和功能恢復之影響。方法：本研究為前瞻性研究，研究對象為中度至重度功能障礙急性腦中風患者，共收集105位病患接受高強度復健，根據察爾森共病症嚴重度指數分析每項共病症與患者出院生活能力之影響。結果：腦中風患者其察爾森共病症嚴重度指數每增加一分，出院時巴氏量表會減少0.97分(p=0.013)。在19項共病症之中，盛行率最高的依序是糖尿病(21%)、曾經腦中風或是暫時性腦缺血病史(17.1%)和糖尿病合併終端器官損壞(14.3%)。共病症對腦中風患者生活能力的影響分析中，發現影響最大的是慢性肺部疾病，之前有偏離病史次之。結論：腦中風患者共病症會影響功能恢復及生活能力，尤其是慢性肺部疾病與中風之前有過半側偏癱病史，其他相關的共病症像是退化性關節炎或是心律不整等問題則需要再研究，期許未來可以建立一個屬於腦中風病人的共病症指標。

並列關鍵字

急性腦血管疾病(acute cerebrovascular disease) ； 共病症(comorbidity) ； 功能恢復(functional recovery)

參考文獻

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