- 期刊
缺血性腦中風病人住院期間所接受的復健治療量與殘障和死亡風險之關係
Association between the Amount of Inpatient Rehabilitation Therapy and the Risk of Disability and Mortality in Patients with Ischemic Stroke
摘要
大多數的研究已經證明對於急性腦中風病人，復健治療可以促進病人功能恢復，減少病人殘障的風險。但是，關於腦中風病人住院期間所接受的復健治療量，和病人發生殘障和死亡風險的關係還不清楚。本研究主要目的是希望探討急性缺血型中風病患住院期間接受的復健治療量，與發生殘障和死亡風險的關係，以及在不同嚴重程度的中風病人，此關係是否不同。本研究為回溯性世代研究，搜集在2008年1月1日到2009年6月30日，診斷為急性缺血性腦中風疾病的病患，在本院住院的病人；排除復發性腦中風及短暫性腦缺血發作的病人後，共收集1277位病患資料。病患的基本資料和相關變項資料由腦中風登錄資料和病歷回顧得到，結果評估（outcome measure）為腦中風發生三個月後的巴氏量表、和追蹤至2009年12月31日病患的存活狀況。在1277位研究對象中，其中男性726位，女性551位，平均年齡為68.3歲，研究追蹤期間共有163人死亡，用Cox比例危險模型調整相關變項後，發現復健治療量越大有較低的死亡率，高復健治療量組病人相對於低復健治療量組病人，死亡的風險比為0.45（0.30-0.65）；用邏輯氏迴歸模型分析，發現高復健治療量組病人相對於低復健治療量組病人，殘障危險率下降43%，同時，腦中風的病人接受復健治療量和殘障及死亡的關係有劑量－反應（dose-response）關係。另外，不論中風的嚴重程度，復健治療量愈大，都能降低中風後的殘障和死亡風險。本研究發現對於缺血性腦中風的病人，增加住院期間復健治療量，可以降低未來發生殘障及死亡的危險。未來需要更多研究去了解阻礙腦中風病人接受復健治療的障礙，臨床醫師也應該儘量鼓勵和轉介腦中風病人接受復健治療。
並列摘要
Background and Purpose: Most studies have demonstrated that rehabilitation program is able to improve functional recovery and reduce the risk of disability in patients with acute stroke. However, the relationship between the amount of the inpatient rehabilitation therapy and the risk of disability and mortality among patients with acute ischemic stroke is still unknown. The present study was undertaken to investigate the relationship between the amount of inpatient rehabilitation therapy and the risk of disability and mortality among patients with acute ischemic stroke, as well as to assess whether the association varies with respect to stroke severity Methods: We designed a retrospective study with a cohort of consecutive adult patients admitted in the Mackay Memorial Hospital, Taipei, for acute ischemic stroke between January 1, 2008 and June 30, 2009 (N=1277). The main outcome measures were the rate of disability (Barthel index less than 60) and the survival rate until December 31^(st), 2009. Results: During the median follow-up period of 12.3 months (ranging from January 1, 2008, to December 31, 2009), 163 deaths occurred. The greater amount of rehabilitation therapy was associated with a reduced risk of disability and mortality (p=0.005, for trend; p ＜0.001 for disability and mortality). Compared with the first tertile, the third tertile of rehabilitation volume was associated with a 34% lower risk of disability (hazard ration [HR]=0.66; 95% confidence interval [CI], 0.50-0.79) and a 55% lower risk of mortality (HR=0.45; 95% CI, 0.30-0.65). The association did not vary with respect to stroke severity (p=0.86, for interaction and p=0.45 for disability and mortality). Conclusions: Current results revealed that increasing the amount of rehabilitation therapy can reduce the risk of disability and mortality in acute ischemic stroke patients. Meanwhile, there exists dose-reaction relationship between the volume of rehabilitation therapy and the reduction of disability and mortality risk.