脑卒中患者延续性护理的研究进展

脑卒中(stroke)又称中风或脑血管意外,是指由于机体脑循环障碍所致的局限或全面性脑功能缺损综合征或急性脑血管病事件,包括脑出血、脑梗死、蛛网膜下腔出血等[1]。脑卒中发病率、死亡率高、致残率和复发率高。目前,国内脑卒中护理的重点在患者住院期间,如超早期的溶栓治疗和护理、急性期的治疗和护理、病情稳定后的早期康复护理[2]。     

脑卒中吞咽困难的康复护理进展

综述脑卒中吞咽困难的康复护理进展,包括吞咽困难的康复评估方法、护理模式在康复护理中的应用以及康复护理、摄食护理等。     

A systematic review of studies investigating the care of stroke survivors in long-term care facilities

Purpose: The burden of stroke is immense, with approximately 30 million stroke survivors globally. Approximately one-quarter of residents in long-term care (LTC) facilities are stroke survivors. This review aims to integrate the existing knowledge from the literature and elucidate themes around the care of stroke survivors in LTC facilities. Method: A systematic search was performed in PubMed, Ovid MEDLINE, the Cochrane Library and CINAHL. Articles that met the eligibility criteria were selected. Synthesis of results according to similar themes was performed. Results: A total of 1920 articles were screened for eligibility, of which 22 met the eligibility criteria. Of the 22 articles selected, five and 17 articles comprised interventional and observational studies, respectively. Three themes were identified: rehabilitation, stroke specific care and secondary stroke drug prevention. These were found to be lacking within LTC facilities. There is also a dearth of interventional studies in stroke survivors from LTC facilities. Conclusions: The care of stroke survivors in LTC facilities is lacking in rehabilitation, stroke specific care and secondary stroke prevention. This needs to be addressed through conducting further research to build a strong body of evidence to influence change in the care of this vulnerable group of patients.

• Implications for Rehabilitation

• Care of stroke survivors in long-term care facilities

• Stroke survivors make up almost a quarter of residents in long-term care facilities. They suffer from functional impairments and many other disabilities as a result of more severe stroke, precluding them from living in their own homes.

• Rehabilitation, stroke-specific care and secondary stroke prevention for stroke survivors are lacking in long-term care facilities despite strong evidence showing benefits for these interventions in stroke survivors living in the community.

• Interventions to address the unmet need in stroke survivors living in long-term care facilities are vital for optimal care of this vulnerable group of patients.

     

康复护理对急性缺血性脑卒中患者肌肉功能康复的影响

目的:探讨康复护理对急性缺血性脑卒中患者肌肉功能恢复的影响.方法:将64例缺血性脑卒中患者随机分为对照组和干预组各32例,两组均接受急性脑卒中常规治疗,对照组实施常规护理,干预组在常规护理的基础上给予康复护理.护理前后分别采用Barthel指数和改良Ashworth评分对两组进行评价.结果:两组护理后Barthel指数与护理前比较有显著提高(P<0.01),但护理后干预组明显高于对照组(P<0.01);护理后干预组肌张力评分与对照组比较差异有统计学意义(P<0.05).结论:康复护理对急性缺血性脑卒中患者功能恢复有一定促进作用,能提高患者的生活质量.     

The nature of nursing care and rehabilitation of female stroke survivors: the perspective of hospital nurses

Aims and objectives. The aim of this study was to explore the nature of nursing care and rehabilitation of female stroke survivors, as described by hospital nurses. The objectives were to uncover how the nurses perceived the care of female stroke survivors and to explore whether, and in what way, the nurses paid attention to the fact that the patients were women. Background. Nursing care is an important aspect of the rehabilitation of stroke survivors. Little attention has been paid to gender differences in the health care system in general and in the nursing profession in particular, although it is reasonable to think that gender issues may have important implications in the rehabilitation process following a stroke. Design. Design was phenomenological with feminist perspective. Methods. The nurses were interviewed in‐depth. In the data analysing process we were inspired by Giorgi's phenomenological method. Results. The nurses were focusing primarily on functional and practical aspects of the women's situation. They perceived the rehabilitation process predominately from a professional rather than the patient point of view, and from a non‐conscious and primarily gender‐neutral perspective. Conclusions. The results indicate that the nurses perceived nursing care primarily in terms of practical actions to promote the body's functional and practical abilities. Little attention was directed to the stroke survivors’ experiences of their life body, nor to the fact that the patients were women. Relevance to clinical practice. In order to promote care from the perspective of the female stroke survivors, we believe it is necessary to attend to the life experiences of the patient, which also mandates paying attention to how gender has an impact on their diseased bodies, every day life, values and preferences in the situation.     

Nursing and rehabilitation: the interventions of nurses in stroke patient care

Summary

• ? The nature of the therapeutic interventions of nurses in the care of stroke patients is at the core of the debate over the exact role of the nurse in patient rehabilitation.
• ? The nature of that intervention is explored in the terms of previous writers in the area through a review of the English language literature published.
• ? The main conclusion is that even though the number and quality of publications has increased significantly, the nature of the nurse's specific interventions are still vague with the result that Henderson's claim for nurses to be the ‘rehabilitator par excellence’ still lies unfulfilled.
• ? This lack of precision enhances the possibility that the nature of the nurse's interventions will be defined and hence potentially constrained by other professionals.

     

脑卒中偏瘫病人早期康复护理的研究进展

脑卒中偏瘫病人的运动功能受损而导致日常生活活动能力下降。对脑卒中偏瘫病人进行早期康复护理能够有效防止并发症的发生,提高现有功能和最大限度地恢复其自理能力。现综述近几年国内外脑卒中偏瘫病人早期康复心理护理、康复时机的选择、康复体位护理、运动功能的康复护理等研究进展。     

中医时间学在中风预防性护理中的运用

对内科103例有高血压病史的中风住院患者进行发病时间和季节的回顾性分析,提示了出血性中风以6:00-18:00发病为多,而缺血性中风以18:00-次日6:00发病为主;中风以春冬季节为发病高峰。表明了随着自然界时间的变化,人的病理活动过程有相应的节律性。因此,在对中风的预防性护理中,根据中风不同病证的昼夜节律而强化护理时间性,严密观察病情变化,严格交接班制度,指导患者有效地用药,调理情志,劳逸结合;根据中风的发病具有季节性的特点,春冬时节应避寒就温,注意四时气候的变化。     

组织化卒中医疗的概念及国内外特征

组织化卒中医疗是指多学科的、合作的和整合的医疗计划,目的是提供给患者最佳医疗服务。最佳医疗服务包括高质量、标准化、有效的和花费效果合适的措施。组织化卒中医疗的基本文件是卒中指南和整合医疗路径。组织化卒中医疗的项目和形式包括欧洲的卒中单元、美国的卒中中心、加拿大阶梯工程和北京组织化卒中医疗体系。     

A framework for care during the stroke experience.

This article describes a model we developed to guide the selection and design of nursing activities that will facilitate the health of persons with stroke and their families. Care in the context of stroke has been structured by the medical model's focus on functional ability. As a result, nursing is viewed as ancillary to other professions; yet, studies of the stroke experience from the patient's view suggest that distinctive nursing interventions are needed. Current models of illness do not sufficiently address the nature of stroke and thus cannot serve as a framework for nursing care. Our model conceptualizes stroke as a progressive, holistic experience with physiological, psychological, and social dimensions. It was developed from a synthesis of research articles identified through searches of CINAHL, MEDLINE, and PSYCHLIT (1980-1999) indexes using the terms "stroke," "stress," "coping," "chronic illness," and "transitions and growth" and from our clinical experiences. Our research established that the stroke experience involves the deterioration of the whole person and the development of a new person through discovery and resynthesis. Each of these processes progressively dominates the experience and together they form a three-phase model. This model of the stroke experience suggests that nursing care should focus initially on limiting deterioration and then concentrate on facilitating growth. Selection of specific interventions requires an understanding of the uniqueness of each stroke experience, as well as the commonalities, among these experiences.     

院前急救对急性脑卒中患者的治疗效果影响研究

目的探讨院前急救对急性脑卒中的临床价值。方法选取2011年1月至2012年12月在该院经院前急救的脑卒中患者70例为观察组,并随机选取自行前来该院就诊的50例患者作为对照组,对2组患者的院前并发症、预后和急救时间进行比较。结果观察组呼吸不畅、脑疝、神经功能后遗症的发生率及病死率均低于对照组,差异有统计学意义（P〈0.05）。观察组院外急救时间明显低于对照组,差异有统计学意义（P〈0.05）。结论有效的院前急救对挽救急性脑卒中患者生命、减少其并发症、改善预后有着非常重要的作用。     

脑卒中偏瘫患者肢体功能早期康复护理体会

目的探讨脑卒中偏瘫患者进行早期康复护理对肢体功能的影响。方法对42例脑卒中偏瘫患者制定康复护理计划,早期康复护理。出院前对比护理前后的肌力变化,了解肢体功能康复程度。结果偏瘫患者肢体肌力均有不同程度的改善,入院时与出院时肌力比较有显著差异(P<0.001)。结论脑卒中偏瘫患者早期进行康复护理,能促进肢体功能恢复、降低致残率、提高生存质量。     

脑卒中致吞咽障碍患者的康复护理现状

简要阐明了脑卒中致吞咽障碍患者的康复护理发展现状和对发病机制的新认识。介绍了以往康复护理方法(直接训练、间接训练和鼻饲护理)和目前较新的两种康复护理方法(五位一体治疗和联合高压氧治疗),提出了重视吞咽障碍患者的综合训练和功能康复锻炼的指导,可提高患者整体康复效果及生存质量。     

Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial

Purpose: Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge.

Method: In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period.

Results: After OHCP, oral hygiene status including the plaque index, calculus index, and O’Leary plaque index improved significantly in the intervention group, compared to the control group (p?p?Conclusions: An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital.

• Implications for Rehabilitation

• Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center.

• An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge.

• Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.

     

Improving stroke care through action research

• ? Stroke accounts for ～20% of beds occupied on general medical wards yet nurses felt inadequately prepared to participate fully in the interdisciplinary approach to stroke rehabilitation.
• ? An action research project was established to improve stroke care and rehabilitation in a general medical ward.
• ? Results indicate a correlation between knowledge and attitudes: the greater the nurse's understanding the more positive the nurse is towards nursing involvement in rehabilitation.
• ? It was concluded that nurses have a vital part to play in the rehabilitation of stroke patients and that their contribution can be enhanced through greater understanding.
• ? Further research is needed to determine the effects of greater nursing involvement in terms of quality of patient recovery and length of patient stay.

     

冰刺激联合穴位针刺康复护理训练改善脑卒中病人吞咽障碍的效果

[目的]探讨对脑卒中吞咽障碍病人早期实施咽部冰刺激联合穴位针刺康复护理训练治疗的效果。[方法]将70例脑卒中吞咽障碍病人随机分为观察组和对照组各35例,对照组采用常规药物治疗及康复训练方法,观察组在此基础上采用冰刺激联合穴位针刺治疗,比较两组病人的治疗效果。[结果]观察组总有效率高于对照组（P〈0．05）。[结论]对脑卒中吞咽障碍病人早期实施咽部冰刺激联合穴位针刺康复护理训练能使病人建立良好的吞咽反射,效果优于常规康复训练方法。     

Assessments and nursing care for right brain-damaged stroke patients: focusing on neglect and related symptoms

The purpose of present study was to identify the behavioural characteristics and examine assessments of nursing care among right brain-damaged stroke patients with neglect within 1 year following initial onset. Characteristics related to higher cerebral dysfunction were extracted and patient grouping was attempted through cognition (Mini-Mental State Examination) and physical function (Barthel Index) plots. The characteristics and implications for nursing care for each group were analyzed. Twelve patients were classified into four groups using cognitive-physical function evaluations together with subjective and objective data associated with neglect. 'Neglect' has been regarded as a disorder of spatial perception. However, the characteristics observed in Group 2 suggest that 'neglect' may have another facet, manifesting as disorders in perceiving continuous spatio-temporal changes of an action and comprehending the context of a situation. In these patients, although 'by calling attention' is the conventional care, more appropriate care should be provided based on an assessment of cognitive-physical function and spatio-temporal recognition of an action.     

Feasibility of a nursing rehabilitation guideline for patients with stroke: evaluating the use by nurses

Purpose: To determine the feasibility of the Clinical Nursing Rehabilitation Stroke-guideline (CNRS-guideline) in the care of stroke patients in terms of the experiences, views and attitudes of nurses towards the guideline and their adoption of the guideline and how often the recommendations were used.

Method: A four phase cross sectional design was used. Demographic data were collected from nurses (n=30) and patients (n=105). After each test phase the nurses received questionnaires about their experiences of the guideline including questions about their attitude towards the guideline and adoption of the guideline. Also, how often the recommendations were used was registered.

Results: The nurses’ general impression of the recommendations scored a median of 6.0. A majority of the nurses indicated that the aims of the guideline were clear, that it provided new insights into stroke care. Among the challenges experienced were lack of knowledge and skills and organizational difficulties. Half of the nurses adopted the guideline and the nurses’ attitude towards the guideline scored a median of 6.0.

Conclusion: The guideline provides nurses with an important means for evidence based care for patients with stroke. The guideline was feasible for nurses to use but various challenges need ongoing attention when planning implementation.

Implication for Rehabilitation

• The CNRGS-guideline was found to be feasible for nurses to use in the daily care of patients with stroke, but various challenges, need an ongoing attention.

• The CNRGS-guideline is an important step in the stimulation of quality improvement and efficiency and may result in better outcome and satisfaction of patients with stroke.

• The CNRGS-guideline provides nurses with an important means to provide evidence based care for patients with stroke.

     

脑卒中患者的家庭护理与康复指导

目的探讨脑卒中患者家庭护理和康复训练指导方法。方法对34例首次发生脑卒中的患者于出院后进行家庭护理方法的指导,实施肢体、语言功能训练及日常生活康复训练,分别采用Fugl-m eyer与Barthel评分方法评定患者的运动能力和日常生活能力。结果通过家庭护理和康复训练指导,提高了脑卒中患者的运动和日常生活功能评分。结论家庭护理和康复训练指导相结合,能够有效改善脑卒中患者的生存质量。