ICU急性出血性脑卒中早期预后因素分析

摘要

Objective To analyze the early prognostic factors of patients with acute intracerebral hemorrhage (AIH) in intensive care unit (ICU). Methods One hundred and ten ICH patients admitted in ICU were recruited and fol owed up for 3 months.The outcomes of patients were assessed with Simple Fugl- Meyer Assessment (FMA) and Function Independent Measure (FIM). The groups were compared with independent samples t- test and one- way ANOVA test. The multiple liner regression analysis were used to assess the independent determinants of FMA and FIM. Results The mean FMA score of patients was 51.37 ± 7.33 (range 30~77), the 25th, 50th and 75th percentile were 46, 51 and 57, respectively. The mean FIM score of patients was 76.72±10.67(range 28~99), the 25th, 50th and 75th percentile were 72, 77 and 84, respectively. Univariate analysis showed that age, lesion and volume of ICH, disorders of consciousness, pulmonary infection, early rehabilitation, limb spastic and shoulder complications were significantly associated with FMA scores (P<0.05);while age, lesion and volume of ICH, disorders of consciousness, pulmonary infection, early rehabilitation, bladder and bowel dysfunction, dysphagia, limb spastic, shoulder complications, sensory dysfunction, apraxia, aphasia and post- stroked depression (PSD) were significantly associated with FIM scores (P<0.05). Multiple linear regression analysis showed that the disorders of consciousness (t=- 2.715, P=0.008), pulmonary infection (t=- 3.475, P=0.001), early rehabilitation (t=2.338, P=0.021) and limb spastic (t=- 6.016, P=0.000) were independent determinants for FMA scores;while early rehabilitation (t=2.569, P=0.012), bladder and bowel dysfunction (t=- 2.821, P=0.006), dysphagia (t=- 5.388, P=0.000), limb spastic (t=- 2.698, P=0.008), apraxia (t=- 3.789, P=0.000) and PSD (t=- 4.805, P=0.000)FIM were independent determinants of FIM scores. Conclusion The prognosis of ICH patients in ICU are influenced by multiple factors. According to these factors, the corresponding measures should be taken to improve the prognosis and the qual-ity of life of ICH patients.%目的：探讨ICU急性出血性脑卒中（ICH）患者早期预后及其影响因素，为临床治疗提供参考。方法收集ICU急性ICH患者110例，随访观察3个月的临床转归情况，采用简化Fugl- Meyer运动功能评定量表（FMA）评定患者的肢体运动功能，功能独立性量表（FIM）评定患者的日常生活活动能力，并分析影响因素。结果 ICH患者FMA评分30~77（51.37±7.33）分，第25、50和75百分位数分别为46、51和57分；FIM评分28~99（76.72±10.67）分，第25、50和75百分位数分别为72、77和84分。患者年龄、出血部位、出血量、发病时意识障碍、肺部感染、早期综合康复治疗、肢体痉挛和肩部并发症等因素在FMA评分中差异均有统计学意义（均P＜0.05）；患者的年龄、出血部位、出血量、发病时意识障碍、肺部感染、早期综合康复治疗、大小便失禁、吞咽障碍、肢体痉挛、肩部并发症、感觉障碍、失用、失语和抑郁等因素在FIM评分中比较差异均有统计学意义（均P＜0.05）。多元线性回归分析结果显示，发病时意识障碍（P=0.008）、肺部感染（P=0.001）、早期综合康复治疗（P=0.021）和肢体痉挛（P=0.000）是ICH患者肢体运动功能的独立影响因素；早期综合康复治疗（P=0.012）、大小便失禁（P=0.006）、吞咽困难（P=0.000）、肢体痉挛（P=0.008）、失用（P=0.000）和抑郁（P=0.000）是ICH日常生活活动能力的独立影响因素。结论 ICU急性ICH患者预后的影响因素包含多个方面，临床可根据这些因素评估患者的病情，制订有针对性的措施以改善患者的功能预后，提高患者的生活质量。