早期综合康复干预对降低脑出血患者并发症发生率的回顾性研究

Retrospective Study of Early Comprehensive Rehabilitation Intervention on Reducing the Incidence of Complications in Patients with Intracerebral Hemorrhage

摘要: 目的：探讨早期综合康复干预与脑出血患者住院期间并发症发生及功能恢复的关系。方法：回顾性收集2024年10月至2025年12月珠海市中西医结合医院脑外科收治的117例脑出血患者临床资料，按病历中首次康复治疗执行记录时间分为早期康复组(发病72小时内开始康复干预，94例)和常规护理组(康复介入晚于72小时或未接受康复干预，23例)。比较两组患者基线资料、住院期间并发症(肺部感染、下肢深静脉血栓)发生情况、住院天数及格拉斯哥昏迷量表(GCS)评分、Barthel指数变化量，并采用二元Logistic回归分析住院期间发生并发症的影响因素。结果：两组年龄、性别构成比较差异均无统计学意义(P > 0.05)；早期康复组出血量大于常规护理组[(17.70 ± 23.49) ml vs (4.37 ± 4.81) ml]，入院时GCS评分[(11.69 ± 3.68)分 vs (14.30 ± 1.84)分]、Barthel指数[(20.48 ± 20.33)分 vs (56.96 ± 33.97)分]均低于常规护理组，住院天数长于常规护理组[(20.07 ± 7.87) d vs (13.26 ± 7.73) d]，差异均有统计学意义(P < 0.01)。早期康复组住院期间并发症总发生率高于常规护理组(77.7% vs 30.4%, P < 0.001)，其中肺部感染发生率高于常规护理组(76.6% vs 21.7%, P < 0.001)，两组下肢深静脉血栓发生率比较差异无统计学意义(24.5% vs 13.0%, P > 0.05)；两组ΔGCS评分、ΔBarthel指数比较差异均无统计学意义(P > 0.05)。二元Logistic回归分析显示，年龄(OR = 1.056, 95%CI: 1.013~1.102, P = 0.011)是住院期间发生并发症的独立危险因素，入院时GCS评分(OR = 0.768, 95%CI: 0.595~0.992, P = 0.043)是独立保护因素，而康复介入时机(组别)并非并发症的独立影响因素(OR = 3.079, 95%CI: 0.865~10.968, P = 0.083)。结论：本研究中早期康复组患者入院病情明显重于常规护理组，其并发症发生率较高主要源于基线病情不平衡；校正混杂因素后，早期康复介入与并发症发生无独立相关性。高龄、入院时意识障碍重是脑出血患者住院期间发生并发症的高危因素，临床应对此类患者加强并发症监测与针对性预防，并在病情允许的前提下尽早实施个体化综合康复干预。

Abstract: Objective: This paper aims to explore the relationship between early comprehensive rehabilitation intervention and complications and functional recovery of patients with intracerebral hemorrhage during hospitalization. Methods: The clinical data of 117 patients with intracerebral hemorrhage admitted to the Department of Brain Surgery of Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from October 2024 to December 2025 were retrospectively collected, and were divided into early rehabilitation group (94 patients started rehabilitation intervention within 72 hours of onset) and routine nursing group (23 patients received rehabilitation intervention later than 72 hours or did not receive rehabilitation intervention) according to the record time of the first rehabilitation treatment in medical records. The baseline data, complications (pulmonary infection, deep venous thrombosis of lower limbs), hospitalization days, Glasgow Coma Scale (GCS) score and Barthel index of the two groups were compared, and the influencing factors of complications during hospitalization were analyzed by binary Logistic regression. Results: There was no significant difference in age and sex composition between the two groups (P > 0.05). The amount of bleeding in the early rehabilitation group was greater than that in the routine nursing group [(17.70 ± 23.49) ml vs (4.37 ± 4.81) ml], and the GCS score [(11.69 ± 3.68) vs (14.30 ± 1.84)] and Barthel index [(20.48 ± 20.33) vs (56.96 ± 33.97)] at admission were lower than those in the conventional nursing group. The length of hospital stay was longer than that of routine nursing group [(20.07 ± 7.87) d vs (13.26 ± 7.73) d], and the difference was statistically significant (P < 0.01). The total incidence of complications in the early rehabilitation group was higher than that in the routine nursing group (77.7% vs 30.4%, P < 0.001), and the incidence of pulmonary infection was higher than that in the routine nursing group (76.6% vs 21.7%, P < 0.001). There was no significant difference in the incidence of deep venous thrombosis between the two groups (24.5% vs 13.0%, P > 0.05). There was no significant difference in ΔGCS score and ΔBarthel index between the two groups (P > 0.05). Logistic regression analysis showed that age (OR = 1.056, 95%CI: 1.013~1.102, P = 0.011) was an independent risk factor for complications during hospitalization, and the GCS score at admission (OR = 0.768, 95%CI: 0.595~0.992, P = 0.043) was an independent protective factor. The timing of rehabilitation intervention (group) was not an independent influencing factor for complications (OR = 3.079, 95%CI: 0.865~10.968, P = 0.083). Conclusion: In this study, the patients in the early rehabilitation group were significantly worse than those in the routine nursing group, and the higher incidence of complications was mainly due to the imbalance of baseline conditions. After adjusting for confounding factors, there was no independent correlation between early rehabilitation intervention and complications. The high risk factors for complications in patients with intracerebral hemorrhage during hospitalization are old age and serious disturbance of consciousness when they are admitted to hospital. Clinically, we should strengthen the monitoring and targeted prevention of complications for such patients, and implement individualized comprehensive rehabilitation intervention as soon as the condition permits.