定期随访对脑梗死恢复期患者神经功能及社会活动功能的影响
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摘要
目的:探讨医务人员院外定期随访对脑梗死恢复期患者神经功能恢复及社会活动功能的影响作用。方法:选取我科急性缺血性卒中经治疗后好转出院患者共151例,分为观察组74例和对照组77例。出院后医务人员根据自制随访流程对观察组进行2周1次的随访,对照组未进行随访,3个月、1年后分别对2组进行改良Rankin评分(mRS)及社会活动功能量表(FAQ)评估。结果:出院3个月后,2组mRS评分、FAQ评分及社会活动功能评定未见统计学差异,观察组残疾率明显低于对照组(P<0.05)。1年后,2组的mRS评分、致残率、FAQ评分及社会活动障碍率均低于3个月时(P<0.05,0.01),且观察组mRS评分、致残率、FAQ评分及社会活动功能障碍率均明显低于对照组(均P<0.05)。结论:医务人员院外定期随访可促进脑梗死恢复期患者神经功能及社会活动功能恢复,功能的恢复较为缓慢。
Objective: To investigate whether the regular follow-up of hospital staff has an effect on the recovery of neurological function and the improvement of social function in patients with cerebral infarction at convalescence stage. Methods: A total of 151 cases of acute ischemic stroke admitted to our department and discharged from the hospital after treatment were randomly divided into an observation group(n=74) and a control group(n=77). The medical staff followed the weekly follow-up according to the self-made follow-up process after discharge, and the control group was not followed up. After 3 months and 1 year, two groups were evaluated by modified Rankin score(mRS) and social function scale(FAQ). Results: There were no statistically significant differences between the two groups in the mRS score, the FAQ score and the rate of social dysfunction after 3 months; and the mutilation rate in the observation group was significantly lower than that in the control group(P<0.05). One year later, the mRS score, disability rate, FAQ score and social activity dysfunction rate in the observation group were significantly lower than those in the control group(P<0.05), and also significantly lower than those in the three months in both groups(P<0.05, 0.01). Conclusion: The medical staff regular follow-up outside the hospital can promote the recovery of neurological function and social function in patients with cerebral infarction. The recovery of social function is slower than that of nerve function.
Objective: To investigate whether the regular follow-up of hospital staff has an effect on the recovery of neurological function and the improvement of social function in patients with cerebral infarction at convalescence stage. Methods: A total of 151 cases of acute ischemic stroke admitted to our department and discharged from the hospital after treatment were randomly divided into an observation group(n=74) and a control group(n=77). The medical staff followed the weekly follow-up according to the self-made follow-up process after discharge, and the control group was not followed up. After 3 months and 1 year, two groups were evaluated by modified Rankin score(mRS) and social function scale(FAQ). Results: There were no statistically significant differences between the two groups in the mRS score, the FAQ score and the rate of social dysfunction after 3 months; and the mutilation rate in the observation group was significantly lower than that in the control group(P<0.05). One year later, the mRS score, disability rate, FAQ score and social activity dysfunction rate in the observation group were significantly lower than those in the control group(P<0.05), and also significantly lower than those in the three months in both groups(P<0.05, 0.01). Conclusion: The medical staff regular follow-up outside the hospital can promote the recovery of neurological function and social function in patients with cerebral infarction. The recovery of social function is slower than that of nerve function.
引文
[1] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J]. 中华神经科杂志, 2015,48(4): 258-273.
[2] Fisher M. Stroke and TIA: epidemiology, risk factors, and the need for early intervention[J]. Am J Manag Care, 2008, 14(2): 204-211.
[3] 林蓓蕾,张振香,孙玉梅. 脑卒中患者功能锻炼依从性及其影响因素的研究现状[J]. 中国慢性病预防与控制,2011,19(5): 542-544.
[4] Touillet A,Guesdon H,Bosser G,et al. Assessment of compliance with prescribed activity by hemiplegic stroke patients after an exercise programme and physical activity education[J]. Ann Phys Rehabil Med, 2010,53(4): 250-257, 257-265.
[5] 钱春荣,朱京慈,陈颖峥. 患者日记结合护理随访干预提高脑卒中患者出院指导的依从性[J]. 解放军护理杂志,2011,28(7): 9-11.
[6] Hinkle J L. Reliability and validity of the National Institutes of Health Stroke Scale for neuroscience nurses[J]. Stroke,2014, 45(3): 32-34.
[7] Sulter G,Steen C,De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials[J]. Stroke,1999,30(8): 1538-1541.
[8] 许贤豪. 神经心理量表检测指南[M]. 北京:中国协和医科大学出版社,2007,68-69.
[9] Wang Y,Xu J,Zhao X,et al. Association of hypertension with stroke recurrence depends on ischemic stroke subtype[J]. Stroke, 2013,44(5): 1232-1237.
[10] 张晓龙,张金涛,彭颖,等. 不同亚型缺血性脑卒中临床特征及出院结局[J]. 中国公共卫生,2012,28(2): 243-244.
[11] 罗菊珍,杨进标,王延红,等. 早期康复护理对急性脑梗死患者生活质量的影响[J]. 中华现代护理杂志,2011,17(4): 420-422.
[12] Lopez-Espuela F,Pedrera-Zamorano J D,Jimenez-Caballero P E,et al. Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study[J]. Am J Crit Care,2016,25(2): 144-151.
[13] Perry L,Hamilton S,Williams J,et al. Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes[J]. Worldviews Evid Based Nurs,2013,10(1): 17-40.
[14] Boltz M,Resnick B,Chippendale T,et al. Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults[J]. J Am Geriatr Soc, 2014,62(12): 2398-2407.
[15] Toots A,Littbrand H,Lindelof N,et al. Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia[J]. J Am Geriatr Soc,2016,64(1): 55-64.
[16] Gouveia B R,Goncalves J H,Martins M M,et al. An evaluation of a nurse-led rehabilitation programme (the ProBalance Programme) to improve balance and reduce fall risk of community-dwelling older people: A randomised controlled trial[J]. Int J Nurs Stud,2016, 56(1): 1-8.
[17] Lopez-Liria R,Vega-Ramirez F A,Rocamora-Perez P,et al. Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care[J]. PLoS One, 2016,11(11): 166-242.
[18] Bernhardt J,Dewey H,Thrift A,et al. Inactive and alone: physical activity within the first 14 days of acute stroke unit care[J]. Stroke,2004,35(4): 1005-1009.
[19] 何宗英,张扬. 情绪干预对提高老年脑梗死患者康复治疗依从性的效果分析[J]. 世界最新医学信息文摘,2017,(3): 70-71.
[2] Fisher M. Stroke and TIA: epidemiology, risk factors, and the need for early intervention[J]. Am J Manag Care, 2008, 14(2): 204-211.
[3] 林蓓蕾,张振香,孙玉梅. 脑卒中患者功能锻炼依从性及其影响因素的研究现状[J]. 中国慢性病预防与控制,2011,19(5): 542-544.
[4] Touillet A,Guesdon H,Bosser G,et al. Assessment of compliance with prescribed activity by hemiplegic stroke patients after an exercise programme and physical activity education[J]. Ann Phys Rehabil Med, 2010,53(4): 250-257, 257-265.
[5] 钱春荣,朱京慈,陈颖峥. 患者日记结合护理随访干预提高脑卒中患者出院指导的依从性[J]. 解放军护理杂志,2011,28(7): 9-11.
[6] Hinkle J L. Reliability and validity of the National Institutes of Health Stroke Scale for neuroscience nurses[J]. Stroke,2014, 45(3): 32-34.
[7] Sulter G,Steen C,De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials[J]. Stroke,1999,30(8): 1538-1541.
[8] 许贤豪. 神经心理量表检测指南[M]. 北京:中国协和医科大学出版社,2007,68-69.
[9] Wang Y,Xu J,Zhao X,et al. Association of hypertension with stroke recurrence depends on ischemic stroke subtype[J]. Stroke, 2013,44(5): 1232-1237.
[10] 张晓龙,张金涛,彭颖,等. 不同亚型缺血性脑卒中临床特征及出院结局[J]. 中国公共卫生,2012,28(2): 243-244.
[11] 罗菊珍,杨进标,王延红,等. 早期康复护理对急性脑梗死患者生活质量的影响[J]. 中华现代护理杂志,2011,17(4): 420-422.
[12] Lopez-Espuela F,Pedrera-Zamorano J D,Jimenez-Caballero P E,et al. Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study[J]. Am J Crit Care,2016,25(2): 144-151.
[13] Perry L,Hamilton S,Williams J,et al. Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes[J]. Worldviews Evid Based Nurs,2013,10(1): 17-40.
[14] Boltz M,Resnick B,Chippendale T,et al. Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults[J]. J Am Geriatr Soc, 2014,62(12): 2398-2407.
[15] Toots A,Littbrand H,Lindelof N,et al. Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia[J]. J Am Geriatr Soc,2016,64(1): 55-64.
[16] Gouveia B R,Goncalves J H,Martins M M,et al. An evaluation of a nurse-led rehabilitation programme (the ProBalance Programme) to improve balance and reduce fall risk of community-dwelling older people: A randomised controlled trial[J]. Int J Nurs Stud,2016, 56(1): 1-8.
[17] Lopez-Liria R,Vega-Ramirez F A,Rocamora-Perez P,et al. Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care[J]. PLoS One, 2016,11(11): 166-242.
[18] Bernhardt J,Dewey H,Thrift A,et al. Inactive and alone: physical activity within the first 14 days of acute stroke unit care[J]. Stroke,2004,35(4): 1005-1009.
[19] 何宗英,张扬. 情绪干预对提高老年脑梗死患者康复治疗依从性的效果分析[J]. 世界最新医学信息文摘,2017,(3): 70-71.