中国居家脑卒中患者的照护现况及对策
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摘要
脑卒中是全球致残、致死的主要原因,且脑卒中患者的发病部位和疾病种类多样,脑卒中患者的照护需求呈多元化,中国平均住院日的缩短使脑卒中患者的居家照护至关重要。但目前面临社区医护人员短缺、照护信息系统不完善、家庭支持能力待提高、社会支持系统不健全等问题。本文将对中国居家脑卒中患者的照护需求、照护形式、照护资源作一综述,阐述目前居家脑卒中患者的照护现状及对策,以期为降低居家脑卒中患者的疾病复发率和再入院率、提高居家脑卒中患者的自护能力、生活质量、减轻家庭、社会负担等提供参考和依据。
Stroke is the main cause of global disability and death.The incidence of stroke patients is diverse and the types of diseases are diverse.The care needs of stroke patients are diversified.The shortening of the average hospitalization day in China makes it essential for home care for stroke patients.However,there are currently problems such as shortage of community medical staff,imperfect care information system,improvement of family support capacity,and imperfect social support system.The article intends to review the care needs,care forms and care resources of patients with stroke at home in China,and expounds the current situation and countermeasures of nursing,in order to provide reference and basis for reducing the recurrence rate and readmission rate of patients with stroke,improving the self-care ability,quality of life,reducing family and social burden of patients with stroke.
Stroke is the main cause of global disability and death.The incidence of stroke patients is diverse and the types of diseases are diverse.The care needs of stroke patients are diversified.The shortening of the average hospitalization day in China makes it essential for home care for stroke patients.However,there are currently problems such as shortage of community medical staff,imperfect care information system,improvement of family support capacity,and imperfect social support system.The article intends to review the care needs,care forms and care resources of patients with stroke at home in China,and expounds the current situation and countermeasures of nursing,in order to provide reference and basis for reducing the recurrence rate and readmission rate of patients with stroke,improving the self-care ability,quality of life,reducing family and social burden of patients with stroke.
引文
[1] BENJAMIN E J,BLAHA M J,CHIUVE S E,et al.Heart Disease and Stroke Statistics-2017 Update:A Report From the American Heart Association[J].Circulation,2017,135(10):e146-e603.
[2] OVBIAGELE B,GOLDSTEIN L B,HIGASHIDA R T,et al.Forecasting the Future of Stroke in the United States:A Policy Statement From the American Heart Association and American Stroke Association[J].Stroke,2013,44(8):2 361-2 375.
[3] 中共中央国务院.《健康中国2030规划纲要》[EB/OL].(2016-10-25)[2017.10.25].http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.
[4] 陈积瑞.常见慢性病住院费用支出与医疗保险报销的相关性研究[D].南京:东南大学,2014.
[5] 陈伟伟,高润霖,刘力生,等.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-530.
[6] HARDIE K.Ten-Year Risk of First Recurrent Stroke and Disability After First-Ever Stroke in the Perth Community Stroke Study[J].Stroke,2004,35(3):731-735.
[7] CONNOLLY T,MAHONEY E.Stroke survivors’ experiences transitioning from hospital to home[J].J Clin Nurs,2018,27(21/22):3 979-3 987.
[8] CHIMATIRO G L.Stroke patients’ outcomes and satisfaction with care at discharge from four referral hospitals in Malawi:A cross-sectional descriptive study in limited resource[J].Malawi Med J,2018,30(3):152-158.
[9] ANDREW N E,BUSINGYE D,LANNIN N A,et al.The Quality of Discharge Care Planning in Acute Stroke Care:Influencing Factors and Association with Postdischarge Outcomes[J].J Stroke Cerebrovasc Dis,2018,27(3):583-590.
[10] MAAS M B,LEV M H,AY H,et al.The Prognosis for Aphasia in Stroke[J].J Stroke Cerebrovasc Dis,2012,21(5):350-357.
[11] PENA-CHAVEZ R,LOPEZ-ESPINOZA M,GUZMAN-INOSTROZA M,et al.Factors associated with post-stroke oropharingeal dysphagia[J].Rev Neurol,2015,61(7):295-300.
[12] HAYWARD K S,KUYS S S,BARKER R N,et al.Can stroke survivors with severe upper arm disability achieve a clinically important change in arm function during inpatient rehabilitation? A multicentre,prospective,observational study[J].NeuroRehabilitation,2014,35(1):17-23.
[13] WARLOW C,OGSTON D,DOUGLAS A S.Deep venous thrombosis of the legs after strokes.Part I--incidence and predisposing factors[J].Br Med J,1976,1(6 019):1 178-1 181.
[14] LIM S F,CHILDS C.A systematic review of the effectiveness of bowel management strategies for constipation in adults with stroke[J].Int J Nurs Stud,2013,50(7):1 004-1 010.
[15] MATSUMURA T,MITANI Y,OKI Y,et al.Risk factors for the onset of aspiration pneumonia among stroke patients in the recovery stage[J].Nihon Ronen Igakkai Zasshi,2014,51(4):364-368.
[16] SUTTIPONG C,SINDHU S.Predicting factors of pressure ulcers in older Thai stroke patients living in urban communities[J].J Clin Nurs,2012,21(3/4):372-379.
[17] AYERBE L,AYIS S A,CRICHTON S,et al.Explanatory factors for the association between depression and long-term physical disability after stroke[J].Age Ageing,2015,44(6):1 054-1 058.
[18] PANDIAN J D,GALL S L,KATE M P,et al.Prevention of stroke:a global perspective[J].Lancet,2018,392(10154):1 269-1 278.
[19] 赵艺璞,胡秀英.我国居家老年人护理需求的文献计量学研究[J].中国实用护理杂志,2015,31(15):1 106-1 113.
[20] 赵艺璞,胡秀英.居家老年人护理需求的文献回顾与分析[J].中国社会医学杂志,2016,33(2):178-181.
[21] ULLBERG T,ZIA E,PETERSSON J,et al.Perceived Unmet Rehabilitation Needs 1 Year After Stroke[J].Stroke,2016,47(2):539-541.
[22] 张小燕,许继晗,苏永静,等.初发脑卒中患者延续性护理需求的调查研究[J].中华护理教育,2012,9(7):294-296.
[23] 王少阳,陈勤,徐晖,等.136例脑卒中患者出院后护理需求的调查分析[J].中国实用神经疾病杂志,2018,21(7):793-795.
[24] 李莹爽,张振香.社区脑卒中患者照护需求的研究进展[J].中国实用神经疾病杂志,2017,20(14):114-116.
[25] 国家卫生计生委医政医管局.《全国护理事业发展规划(2016-2020年)》[EB/OL].(2016-11-24)[2017-11-11].http://www.nhfpc.gov.cn/yzygj/s3593/201611/92b2e8f8cc644a899e9d0fd572aefef3.shtml.
[26] 宗旭余,胡永勤,王来根,等.杭州市余杭区社区卫生服务站人力资源现状分析[J].中国农村卫生事业管理,2013,33(4):375-376.
[27] OLIVIER C L,PHILLIPS J,ROY D E.To be or not to be? A caregiver's question:the lived experience of a stroke family during the first 18 months poststroke[J].Scand J Caring Sci,2018,32(1):270-279.
[28] 吴志军,简伟研.老年慢性病患者社区健康管理服务可获得性及社会决定因素研究[J].中国全科医学,2015,18(28):3 469-3 472.
[29] CHERYL L,JOAN E,ANDREW C,et al.Patient Classification in Home Health Care:Are We Ready[J].Public Health Nurs,1990,7(3):130-137.
[30] 吴林秀,应燕萍,罗霰宇.出院高血压患者Triangle分层分级管理标准的制定[J].中国全科医学,2017,20(12):1 415-1 422.
[2] OVBIAGELE B,GOLDSTEIN L B,HIGASHIDA R T,et al.Forecasting the Future of Stroke in the United States:A Policy Statement From the American Heart Association and American Stroke Association[J].Stroke,2013,44(8):2 361-2 375.
[3] 中共中央国务院.《健康中国2030规划纲要》[EB/OL].(2016-10-25)[2017.10.25].http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.
[4] 陈积瑞.常见慢性病住院费用支出与医疗保险报销的相关性研究[D].南京:东南大学,2014.
[5] 陈伟伟,高润霖,刘力生,等.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-530.
[6] HARDIE K.Ten-Year Risk of First Recurrent Stroke and Disability After First-Ever Stroke in the Perth Community Stroke Study[J].Stroke,2004,35(3):731-735.
[7] CONNOLLY T,MAHONEY E.Stroke survivors’ experiences transitioning from hospital to home[J].J Clin Nurs,2018,27(21/22):3 979-3 987.
[8] CHIMATIRO G L.Stroke patients’ outcomes and satisfaction with care at discharge from four referral hospitals in Malawi:A cross-sectional descriptive study in limited resource[J].Malawi Med J,2018,30(3):152-158.
[9] ANDREW N E,BUSINGYE D,LANNIN N A,et al.The Quality of Discharge Care Planning in Acute Stroke Care:Influencing Factors and Association with Postdischarge Outcomes[J].J Stroke Cerebrovasc Dis,2018,27(3):583-590.
[10] MAAS M B,LEV M H,AY H,et al.The Prognosis for Aphasia in Stroke[J].J Stroke Cerebrovasc Dis,2012,21(5):350-357.
[11] PENA-CHAVEZ R,LOPEZ-ESPINOZA M,GUZMAN-INOSTROZA M,et al.Factors associated with post-stroke oropharingeal dysphagia[J].Rev Neurol,2015,61(7):295-300.
[12] HAYWARD K S,KUYS S S,BARKER R N,et al.Can stroke survivors with severe upper arm disability achieve a clinically important change in arm function during inpatient rehabilitation? A multicentre,prospective,observational study[J].NeuroRehabilitation,2014,35(1):17-23.
[13] WARLOW C,OGSTON D,DOUGLAS A S.Deep venous thrombosis of the legs after strokes.Part I--incidence and predisposing factors[J].Br Med J,1976,1(6 019):1 178-1 181.
[14] LIM S F,CHILDS C.A systematic review of the effectiveness of bowel management strategies for constipation in adults with stroke[J].Int J Nurs Stud,2013,50(7):1 004-1 010.
[15] MATSUMURA T,MITANI Y,OKI Y,et al.Risk factors for the onset of aspiration pneumonia among stroke patients in the recovery stage[J].Nihon Ronen Igakkai Zasshi,2014,51(4):364-368.
[16] SUTTIPONG C,SINDHU S.Predicting factors of pressure ulcers in older Thai stroke patients living in urban communities[J].J Clin Nurs,2012,21(3/4):372-379.
[17] AYERBE L,AYIS S A,CRICHTON S,et al.Explanatory factors for the association between depression and long-term physical disability after stroke[J].Age Ageing,2015,44(6):1 054-1 058.
[18] PANDIAN J D,GALL S L,KATE M P,et al.Prevention of stroke:a global perspective[J].Lancet,2018,392(10154):1 269-1 278.
[19] 赵艺璞,胡秀英.我国居家老年人护理需求的文献计量学研究[J].中国实用护理杂志,2015,31(15):1 106-1 113.
[20] 赵艺璞,胡秀英.居家老年人护理需求的文献回顾与分析[J].中国社会医学杂志,2016,33(2):178-181.
[21] ULLBERG T,ZIA E,PETERSSON J,et al.Perceived Unmet Rehabilitation Needs 1 Year After Stroke[J].Stroke,2016,47(2):539-541.
[22] 张小燕,许继晗,苏永静,等.初发脑卒中患者延续性护理需求的调查研究[J].中华护理教育,2012,9(7):294-296.
[23] 王少阳,陈勤,徐晖,等.136例脑卒中患者出院后护理需求的调查分析[J].中国实用神经疾病杂志,2018,21(7):793-795.
[24] 李莹爽,张振香.社区脑卒中患者照护需求的研究进展[J].中国实用神经疾病杂志,2017,20(14):114-116.
[25] 国家卫生计生委医政医管局.《全国护理事业发展规划(2016-2020年)》[EB/OL].(2016-11-24)[2017-11-11].http://www.nhfpc.gov.cn/yzygj/s3593/201611/92b2e8f8cc644a899e9d0fd572aefef3.shtml.
[26] 宗旭余,胡永勤,王来根,等.杭州市余杭区社区卫生服务站人力资源现状分析[J].中国农村卫生事业管理,2013,33(4):375-376.
[27] OLIVIER C L,PHILLIPS J,ROY D E.To be or not to be? A caregiver's question:the lived experience of a stroke family during the first 18 months poststroke[J].Scand J Caring Sci,2018,32(1):270-279.
[28] 吴志军,简伟研.老年慢性病患者社区健康管理服务可获得性及社会决定因素研究[J].中国全科医学,2015,18(28):3 469-3 472.
[29] CHERYL L,JOAN E,ANDREW C,et al.Patient Classification in Home Health Care:Are We Ready[J].Public Health Nurs,1990,7(3):130-137.
[30] 吴林秀,应燕萍,罗霰宇.出院高血压患者Triangle分层分级管理标准的制定[J].中国全科医学,2017,20(12):1 415-1 422.