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脑卒中患者连续康复护理模式应用效果观察

作者 / Author:张如瑞

摘要 / Abstract:

目的 研究连续康复护理模式在脑卒中患者的应用效果。方法 选择2013-05—2015-05南阳市中心医院收治的104例脑卒中患者作为研究对象,2组按照数字随机法分为对照组和观察组,每组52例。其中对照组患者进行常规护理,观察组患者则进行连续康复护理,比较2组的护理效果。结果 观察组护理后的Barthel指数和FAM运动功能评分均显著优于对照组;观察组护理期间依从率为96.15%,显著高于对照组的82.69%;观察组护理后生理功能、社会功能、情感职能以及精神健康等生活质量指标评分均显著高于对照组,差异均具有统计学意义(P<0.05)。结论 连续康复护理对脑卒中患者的护理效果更好,可有效改善运动功能,提高日常生活能力评分和治疗依从性,提供生活质量安全性高,实用性强,值得临床推荐。

关键词 / KeyWords:

连续康复护理,脑卒中,护理效果,Barthel指数,FAM运动功能评分
脑卒中患者连续康复护理模式应用效果观察
张如瑞
南阳市中心医院神经内科,河南南阳 473000
作者简介:张如瑞,Email:zrr0707@126.com
 
摘要 目的 研究连续康复护理模式在脑卒中患者的应用效果。方法 选择2013-05—2015-05南阳市中心医院收治的104例脑卒中患者作为研究对象,2组按照数字随机法分为对照组和观察组,每组52例。其中对照组患者进行常规护理,观察组患者则进行连续康复护理,比较2组的护理效果。结果 观察组护理后的Barthel指数和FAM运动功能评分均显著优于对照组;观察组护理期间依从率为96.15%,显著高于对照组的82.69%;观察组护理后生理功能、社会功能、情感职能以及精神健康等生活质量指标评分均显著高于对照组,差异均具有统计学意义(P<0.05)。结论 连续康复护理对脑卒中患者的护理效果更好,可有效改善运动功能,提高日常生活能力评分和治疗依从性,提供生活质量安全性高,实用性强,值得临床推荐。
关键词】 连续康复护理;脑卒中;护理效果;Barthel指数;FAM运动功能评分
中图分类号】  R473.74    【文献标识码】  A    【文章编号】  1673-5110(2019)03-0323-07  DOI:10.12083/SYSJ.2019.03.059
 
Observation on the effect of continuous rehabilitation nursing model in patients with cerebral apoplexy
ZHANG Rurui
Department ofNeurologyNanyang Central HospitalNanyang 473000,China
Abstract  Objective  To study the effect of continuous rehabilitation nursing in stroke patients.Methods  104 patients with cerebral apoplexy from May 2013 to May 2015 were selected as subjects.The patients were randomly divided into two groups:control group and observation group with 52 cases in each group.The patients in the control group were given routine nursing care.The patients in the observation group were given continuous rehabilitation nursing,and the nursing effects of the two groups were compared.Results  The Barthel index and FAM motor function score of the patients in the observation group were significantly better than the control group after nursing care.In the observation group,the compliance rate of the patients during nursing was 96.15%,which was significantly higher than the control group of 82.69%.The scores of physiological function,social function,emotional function and mental health in the observation group were significantly higher than the control group (P<0.05).Conclusion  Continuous rehabilitation nursing is better for stroke patients and can effectively improve motor function.Which can improve the score of daily life and therapeutic compliance,provide high quality of life safety practicability,worthy of clinical recommendation.
Key words】  Continuous rehabilitation nursing;Stroke;nursing effect;Barthel index;FAM motor function score
 
        脑卒中是临床上的常见病、多发病,具体包括缺血性卒中和出血性卒中,是一种脑部血液循环障碍性疾病,具有致死率高、致残率高的特点[1-7]。随着医学的发展,脑卒中的致死率有所下降,但致残率仍较高,在70%以上,常见的功能障碍偏瘫,严重者往往卧床不起,丧失生活能力,严重影响患者的生活质量,加重了家庭和社会负担[8-15]。研究表明,良好的护理可有效改善患者的生活质量,促进身体恢复[16-23]。鉴于此,南阳市中心医院在常规护理的基础上进行改进,对部分患者进行连续康复护理,并与常规护理组进行效果对比。
 
1  资料和方法
1.1  临床资料  选择2013-05—2015-05南阳市中心医院收治的104例脑卒中患者作为研究对象,所有患者均符合第4次我国脑血管疾病学术会议制定的诊断标准[24-25],并经MRI或头颅CT价差确诊;排除合并其他严重脏器官疾病以及意识不清的患者。所有患者临床表现为颅内压上升、惊厥、偏瘫等。将上述患者按照数字随机发分为对照组和观察者2组,每组52例。对照组男29例,女23例,年龄(62.33±2.39)岁;观察组男30例,女22例,年龄(61.27±2.31)岁。所有患者均签署知情同意书,且各方面差异无统计学意义,具有可比性。
1.2  方法 对照组患者进行常规护理,主要包括密切关注生命体征、抗痉挛体位摆放、定期进行肢体主、被动活动以及必要的饮食指导等。观察者患者则在对照组的基础上进行连续康复护理,主要措施如下:(1)进行必要的心理护理:安排护理人员向患者讲解一些疾病的相关知识和治疗方案,使患者了解积极配合治疗的意义;治疗过程中护理人员加强与患者的沟通,观察患者的情绪变化,及时对不良情绪进行排解,帮助患者树立正确的治病观,增强患者康复的信心;(2)对患者及其家属进行健康宣教,告知患者及其家属脑卒中的诱发因素、临床特征以及具体的治疗方法和护理方法,使患者了解治疗过程,了解积极治疗和护理的重要性;(3)护理人员保持乐观积极的态度对患者进行必要的康复护理指导,包括抗痉挛体位摆放、关节被动活动等基础训练,还要进行日常生活活动能力、转移训练和站立训练等;(4)对患者进行用药指导,护理人员积极督促患者按照医嘱进行药物服用,禁止随意增减或停药;告诉患者在服药过程中出现任何不适及时告知,由医生指导,让患者明白遵医嘱对疾病治疗的重要作用。
1.3  观察指标  (1)采用Barthel指数和FMA运动功能[26-33]分别对患者护理前后的肢体运动功能进行评定并比较;(2)比较2组患者的治疗依从性[34-42]:依从:可以自主的定时进行服药,积极配合治疗和护理;比较依从:患者偶尔会忘记服药,但经提醒后会进行服药并配合治疗;不依从:患者需要护理人员多番提醒和督促方能进行服药和配合治疗;(3)2组比较2组患者的生活质量,从生理功能、社会功能、情感职能以及精神健康等方面进行。
1.4  统计学方法 通过SPSS 21.0统计软件分析,计量资料以均数±标准差(x±s)表示,组间比较采用t检验,计数资料以百分率(%)表示,采用χ2检验,P<0.05为差异有统计学意义。
 
2  结果
2.1  2组护理前后肢体运动功能评分对比 观察组患者护理后的Barthel指数和FAM运动功能评分均显著优于对照组,差异具有统计学意义(P<0.05)。见表1。
2.2  2组治疗依从性对比 观察组患者护理期间依从率为96.15%,显著高于对照组的82.69%,差异具有统计学意义(P<0.05)。见表2。
2.3  2组生活质量对比  观察组患者护理后生理功能、社会功能、情感职能以及精神健康等生活质量指标评分均显著高于对照组,差异具有统计学意义(P<0.05)。见表3。
 
表1  2组护理前后的肢体运动功能评分对比  (x±s)
Table 1  Comparison of limb motor function scores before and after treatment in 2 groups  (x±s
组别 n Barthel指数   FAM运动功能
护理前 护理后   护理前 护理后
对照组 52 38.41±2.08 49.23±1.41   35.33±1.57 54.35±3.52
观察组 52 37.61±2.12 75.61±1.33   35.21±1.44 72.11±2.24
t   1.942 98.142   0.406 30.695
P   0.055 0   0.686 0
表2  2组治疗依从性对比  [n(%)]
Table 2  Comparison of treatment compliance in 2 groups  [n(%)] 
组别 n 依从 比较依从 不依从 依从率
对照组 52 28(53.85) 15(28.85) 9(17.31) 43(82.69)
观察组 52 39(75.00) 11(21.15) 2(3.85) 50(96.15)
χ2   5.076 0.821 4.981 4.981
P   0.024 0.365 0.026 0.026
表3  2组生活质量对比  (x±s)
Table 3  Comparison of quality of life between of 2 groups  (x±s)
组别 n 生理功能 社会功能 情感职能 精神健康
对照组 52 52.35±4.32 52.23±3.41 61.33±1.57 64.35±3.52
观察组 52 64.34±4.29 67.61±3.33 77.21±2.44 81.11±2.94
t   14.201 23.269 39.467 26.352
P   0.000 0.000 0.000 0.000
3  讨论
        脑卒中具有较高的发病率、致残率以及病死率,近年来,虽然病死率有所降低,但致残率仍较高,且严重影响患者的生活质量和身心健康,增加了家庭和社会的负担[43-50]。良好的护理可以促进患者恢复,因此对护理方案进行改进尤为重要。减少患者功能障碍、提高患者生活质量,使其回归家庭,甚至重返社会时康复护理工作关注的问题,对脑卒中患者进行连续康复护理具有很好的可行性[51-57]
        本研究显示,观察组患者护理后的Barthel指数和FAM运动功能评分均显著优于对照组,且观察组患者护理期间依从率显著高于对照组。提示连续康复护理不仅可提高患者的运动功能评分,还可提高患者的治疗依从性[58-62]。究其原因:连续康复护理是在常规护理的基础上进行的改进,注重对患者肢体的运动和脑卒中知识的普及以及药物的监督与指导,让患者充分了解到遵循医嘱的重要性,因此治疗依从性得到了普遍提高;进行的康复护理指导,包括抗痉挛体位摆放、关节被动活动等基础训练和日常生活活动能力、转移训练和站立训练等,更好地促使患者运动功能恢复[63-65]。此外,观察组患者护理后生理功能、社会功能、情感职能以及精神健康等生活质量指标评分均显著高于对照组,提示连续康复护理较常规护理更能促进脑卒中患者生理、社会和角色功能的快速改善,推测可能患者日常生活能力恢复较好,护理人员积极的心理护理,使得患者可以积极排解不良情绪有关[66-68]。这在管君花等[69-70]的报道结果中也有类似的结论能够佐证。
        连续康复护理对脑卒中患者的护理效果更好,可有效改善运动功能,提高日常生活能力评分和治疗依从性,提供生活质量安全性高,实用性强。
 
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(收稿2018-04-22)
本文责编:关慧
本文引用信息:张如瑞.脑卒中患者连续康复护理模式应用效果观察[J].中国实用神经疾病杂志,2019,22(3):323-329.DOI:10.12083/SYSJ.2019.03.059

Reference informationZHANG Rurui.Observation on the effect of continuous rehabilitation nursing model in patients with cerebral apoplexy[J]Chinese Journal of Practical Nervous Diseases201922(3)323-329.DOI10.12083/SYSJ.2019.03.059

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