早期離床が不動関連合併症と機能予後に及ぼす影響—中等症以上の脳卒中患者に対する後方視的研究

Effects of Early Mobilization on Complications of Immobility and Functional Prognosis in Patients with Moderate-to-severe Stroke : A Retrospective Study

要旨　目的：近年，脳卒中の死亡率は改善し，早期離床は重度の後遺症を持つ患者に対しても積極的に実施されている．しかし，早期離床の効果に関する先行研究では，対象者の多くの割合を脳卒中軽症例が占めており，疾患の重症度の影響が加味されていない．本研究では，中等症以上の脳卒中患者に限定して，48時間以内の早期離床による不動関連合併症と機能予後について検討した．

方法：中等症以上の脳梗塞，脳出血患者83例を対象とした．早期離床群と離床遅延群の2群に分け，不動関連合併症（肺炎，尿路感染症，深部静脈血栓症，褥瘡，肺塞栓症）の発生と機能予後（急性期病院退院時のmodified Rankin scale（mRS））に及ぼす影響を後方視的に調査した．

結果：早期離床群では不動関連合併症のうち肺炎の発症率と急性期退院時mRSの割合が有意に低下した（p＜0.01）．

結論：中等症以上の脳卒中患者への早期離床は特に肺炎の予防に寄与し，機能改善も得られる可能性が示唆された．

Abstract　Objective: Early mobilization is associated with improved mortality rates and is therefore actively implemented in recent years even for patients with severe stroke. Although previous studies reported the effects of early mobilization with stroke, few have fully considered background factors such as severity of stroke. The purpose of this study was to investigate the effects of early mobilization (within 48 hours) on complications of immobility and the functional prognosis in patients with moderate-to-severe stroke.

Methods: The study included 83 patients diagnosed with moderate-to-severe stroke (ischemic or hemorrhagic). Patients were categorized into those who underwent early mobilization and those who underwent mobilization after 48 hours. We retrospectively investigated the effects of early mobilization on complications of immobility (pneumonia, urinary tract infection, deep-vein thrombosis, pressure sores, and pulmonary embolism) and functional prognosis (modified Rankin scale at discharge or moving on to convalescent rehabilitation).

Results: The incidence of pneumonia and the percentage of patients with a modified Rankin scale score at discharge was significantly lower in the early mobilization than in the late mobilization group (mobilization after 48 hours)(p<0.01).

Conclusion: Early mobilization was of significance for preventing complications associated with immobility, especially pneumonia, and for improvement in functional prognosis.