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2018 年第 9 期 第 13 卷

中期照护在老年脑卒中患者中的应用效果

Application effect of intermediate care on elderly patients with stroke

作者:郑添茹陈峥王垚高茂龙

英文作者:

单位:100095北京老年医院老年病临床与康复研究所[郑添茹(天津中医药大学2015级老年医学专业硕士研究生)、陈峥、高茂龙],老年示范病房(王垚)

英文单位:

关键词:脑卒中;中期照护

英文关键词:

  • 摘要:
  • 【摘要】目的    探讨老年脑卒中患者中期照护服务模式的应用性和实践性,进一步论证中期照护服务对老年脑卒中患者日常生活能力(ADL)、认知功能等的干预效果。方法    选取2016年6—12月于北京老年医院住院的急性脑卒中急性期病情稳定达到出院标准的患者80例,按照随机数字表法分为观察组和对照组,各40例。观察组在中期照护病房进行医疗、康复和护理的综合治疗2周。对照组脑卒中常规治疗结束后出院回家或按家属意愿转入其他医院继续治疗。比较2组患者急性期治疗结束入组时、治疗2周及随访6、12个月时的ADL量表、简易智能评估量表(MMSE)、老年抑郁量表(GDS-15)、跌倒风险测定量表(FRA)、简易营养评估量表(MNA)及EuroQo1健康指数量表(EQ-5D)等的评分。结果    本研究最终纳入统计分析76例,观察组37例,对照组39例。2组脑卒中患者入组时一般资料比较差异均无统计学意义(均P>0.05)。观察组治疗2周及随访6、12个月时ADL、GDS-15、FRA、EQ-5D评分均低于对照组[治疗2周:(21.5±5.8)分比(28.3±2.1)分、(1.9±1.8)分比(3.2±2.9)分、(9.9±2.6)分比(10.9±7.3)分、(2.4±1.8)分比(4.6±2.3)分;随访6个月:(19.1±5.8)分比(28.2±2.6)分、(1.5±0.9)分比(3.2±2.7)分、(9.3±2.3)分比(10.6±7.7)分、(2.2±1.7)分比(2.7±1.7)分;随访12个月:(17.4±7.8)分比(28.7±3.7)分、(1.6±1.3)分比(3.3±2.8)分、(9.2±2.4)分比(10.6±7.6)分、(2.1±1.7)分比(2.2±1.5)分],MMSE、MNA评分均高于对照组[治疗2周:(28±3)分比(20±91)分、(19.5±2.7)分比(15.2±4.5)分;随访6个月:(28±3)分比(21±9)分、(19.4±2.9)分比(13.3±1.8)分;随访12个月:(29±3)分比(21±9)分、(19.4±3.0)分比(13.3±2.0)分],差异均有统计学意义(均P<0.05)。结论    中期照护对急性期后老年脑卒中患者在提高ADL、改善健康状况、减少跌倒风险及改善营养状况等方面作用明显,同时对改善脑卒中后抑郁和认知功能也有一定的临床意义。

  • 【Abstract】Objective    To observe the feasibility and practicability of intermediate care service in elderly stroke patients, and to analyze the effect on activity of daily living(ADL) and cognitive function. Methods    From June to December 2016, 80 elderly patients with stroke were enrolled in Beijing Geriatric Hospital. They were randomly divided into observation group and control group, with 40 cases in each group. The observation group was treated with medical care treatment, rehabilitation and nursing at the intermediate care unit for 2 weeks. Patients in the control group discharged after conventional treatment for stroke or they were transferred to other hospitals to continue the treatment. ADL scale, Mini-Mental State Examination(MMSE), Geriatric Depression Scale-15(GDS-15), Fall Risk Assessment(FRA), Mini-Nutritional Assessment(MNA) and European Quality of 5 Dimensions(EQ-5D) were assessed. Results    Thirty-seven patients in the observation group and 39 patients in the control group were included. General clinical data were similar between groups(P>0.05). At 2, 6, 12 weeks after rehabilitation therapy, ADL, GDS-15, FRA, EQ-5D scores in the observation group were significantly lower than those in the control group[2 weeks after treatment:(21.5±5.8) vs (28.3±2.1), (1.9±1.8) vs (3.2±2.9), (9.9±2.6) vs (10.9±7.3)scores, (2.4±1.8) vs (4.6±2.3); 6 months of follow-up: (19.1±5.8) vs (28.2±2.6), (1.5±0.9) vs (3.2±2.7), (9.3±2.3) vs (10.6±7.7), (2.2±1.7) vs (2.7±1.7); 12 months of follow-up: (17.4±7.8) vs (28.7±3.7), (1.6±1.3) vs (3.3±2.8), (9.2±2.4) vs (10.6±7.6), (2.1±1.7) vs (2.2±1.5)]; MMSE and MNA scores in the observation group were significantly higher than those in the control group[2 weeks after treatment: (28±3) vs (20±91), (19.5±2.7) vs (15.2±4.5); 6 months of follow-up: (28±3) vs (21±9), (19.4±2.9) vs (13.3±1.8); 12 months of follow-up: (29±3) vs (21±9), (19.4±3.0) vs (13.3±2.0)](all P<0.05). Conclusion    Intermediate care can significantly improve ADL and health status, reduce fall risk and improve nutritional status in elderly stroke patients; it also has certain effect on post-stroke depression and cognitive function.

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