透析を実施しながら回復期リハビリテーション病棟でのリハビリテーションを行った脳卒中患者の検討

An Examination of Stroke Patients Undergoing Rehabilitation in a Convalescent Rehabilitation Ward While Receiving Dialysis Treatment

要旨：2012年4月の診療報酬改定により回復期リハビリテーション病棟で人工透析が出来高算定可能となった．透析を実施しながら回復期リハビリテーション病棟でのリハビリテーションを行った脳卒中患者4名について，年齢，性別，疾患名，透析歴，急性期入院期間，回復期入院期間，一日訓練単位数，退院先，退院後の通院手段，合併症，FIMについて検討した．対象者の平均年齢は71.0±9.5歳で，男性2名，女性2名で，脳出血2例，脳梗塞2例であった．透析歴は16.8±21.7カ月で，急性期入院期間は50.0±20.3日，回復期入院期間は120.0±28.2日であった．1日平均訓練単位数は回復期リハビリテーション病棟で6.01±1.17単位であった．回復期入院時の全FIM値は59.3±19.2，退院時94.5±27.0，FIM効率は0.29±0.16であった．退院先は全例自宅であった．合併症として腎性貧血の進行3名，シャント血管狭窄1名，せん妄1名を認めた．回復期リハビリテーション病棟での入院リハビリテーションは訓練量増加により透析患者でも能力向上し，非透析患者と同様に在宅復帰につながると考えられた．

Abstract : Dialysis treatment was first introduced in the convalescent rehabilitation ward after the medical fee revision in April 2012 in Japan. In this study, we examined 4 stroke patients who underwent rehabilitation in the convalescent rehabilitation ward while receiving dialysis. We collected information on the patients' age, sex, disease, dialysis period, duration of hospitalization during the acute and recovery phases, the number of units of exercise, discharge destination after hospital, complications, and their Functional Independence Measure (FIM) scores. The average age of the subjects (2 men and 2 women) was 71.0±9.5 years. Two of the 4 patients had cerebral hemorrhage and the other 2 had cerebral infarction. The dialysis period was 16.8±21.7 months. The duration of hospitalization during the acute phase was 50.0±20.3 days, while that in the convalescent rehabilitation ward was 120.0±28.2 days. The average exercise amount per day was 6.01±1.17 units in the convalescent rehabilitation ward. The total FIM score was 59.3±19.2 at admission and 94.5±27.0 at discharge. The FIM efficiency was 0.29±0.16. In all cases, the discharge destination was home. Three of the subjects showed progression of their renal anemia. One subject developed shunt vessel stenosis and one developed delirium as complications. We conclude that rehabilitation in the convalescent rehabilitation ward for dialysis is beneficial to patients due to the increased amount of exercise that they receive. In addition, such rehabilitation enables the patients to return home in good health, similar to the case of non-dialysis patients.