不同性别脑卒中照顾者照顾负担分析

目的了解不同性别脑卒中照顾者关于照顾负担的感受状况,为建立合理的长期照护体系提供科学依据。方法采取便利抽样法,抽取212例脑卒中患者的主要照顾者进行面对面问卷调查。结果男性和女性照顾者在照顾负担平均得分分别为(38.49±5.163)分和(42.46±7.409)分,均处于中等水平,在"时间依赖性负担""发展受限性负担""身体性负担""社交性负担""情感性负担"方面差异均有统计学意义(P0.05)。多元线性回归分析显示,文化程度、照顾时间是影响男性照顾者负担得分的主要因素;文化程度、照顾时间和婚姻状态是影响女性照顾者负担得分的主要因素。结论应重视加强对教育程度低、照顾时间长的中老年人群和已婚女性的支持力度,倡导男女分工协作,促进患者早日康复。     

住院脑卒中患者主要照顾者照顾负担与积极感受的相关性研究

目的：调查住院脑卒中患者主要照顾者照顾负担和积极感受的现状,并探讨两者之间的关系。方法应用Zarit照顾者负担量表和照顾者积极感受量表,将260例住院脑卒中患者的主要照顾者作为研究对象进行调查。结果260例住院脑卒中患者的主要照顾者的照顾负担为轻、中度,积极感受为中等偏高水平,责任负担与生活展望呈显著负相关,照顾负担总分与积极感受总分呈负相关。结论医护人员应对住院脑卒中患者的主要照顾者的照顾负担进行个体化干预,以减轻照顾负担,提高其个人积极感受,最终提高生活质量。     

协同护理对住院脑卒中患者主要照顾者照顾负担的影响

脑卒中主要是老年人常发生的脑血管病变,具有高发性、高复发率、康复慢、不可预测性等特点,给患者、家庭和社会造成了沉重的负担[1]。急性脑卒中患者致残率在存活者中高达80%以上[2]。家庭主要照顾者负担加重,直接影响主要照顾者健康情况、经济情况、心理情况、生活质量等,引起社会的高度重视。近年来提倡一种新颖的护理模式—协同护理,即在责任制护理基础上,通过护理干预,充分利用患者及主要照顾者的护理能力,     

老年脑卒中患者配偶照顾者照顾行为现状及影响因素分析

目的：基于自我管理模式评估老年脑卒中患者配偶照顾者的照顾行为,了解其照顾行为现状及相关影响因素。方法采用自制照顾行为评估问卷对78例脑卒中患者配偶照顾者进行问卷调查。结果配偶照顾者疾病自我管理相关照顾行为得分26.74±3.78,处于低等水平。配偶年龄、照顾年限是影响其照顾行为的主要因素（P＜0.05）。结论医院及相关部门需给予配偶照顾者相关的教育和指导,改善其照顾行为,提高其照顾水平,进而改善脑卒中患者的康复效果,使其早日回归社会。     

脑卒中后遗症患者主要家庭照顾者照顾需求的研究

目的探讨脑卒中后遗症患者其主要家庭照顾者的照顾需求情况,并分析其影响因素。方法采用便利抽样法,抽取115例脑卒中后遗症患者其主要家庭照顾者进行问卷调查。结果脑卒中后遗症患者主要家庭照顾者照顾需求得分处于中等水平(57.04±5.85),其中照顾需求最高的为康复训练,其次为疾病管理,照顾者文化程度、是否伴慢性病及患者生活自理能力是主要家庭照顾者照顾需求的影响因素。结论脑卒中后遗症患者主要家庭照顾者对于康复训练及疾病管理方面存在较高的需求,医务人员应当加强相关方面的指导与教育,同时推进延续性护理的发展,以保证脑卒中后遗症患者及其主要家庭照顾者在医院或家庭均能够得到持续的个体化护理指导和健康教育。     

住院脑卒中主要照顾者照顾积极感受及影响因素

目的探讨住院脑卒中主要照顾者照顾积极感受现状及影响因素。方法 2013-08—12选择平顶山市某三级综合医院260例脑卒中主要照顾者,使用照顾者积极感受量表(positive aspects of caregiving,PAC)、脑卒中患者及主要照顾者一般资料进行调查。结果自我肯定(25.46±4.43)分,展望(13.04±2.57)分,积极感受总分(38.50±6.8)分。多元逐步回归显示,家庭月收入、婚姻状况、是否与患者同住、自觉健康状况是照顾者积极感受影响因素,可解释51.2%的总变异量。结论脑卒中主要照顾者照顾积极感受存在,且为中等偏上水平;临床工作者应结合其影响因素给予针对性支持,以提高主要照顾者心理健康及生活质量水平。     

应对方式对肺癌家庭照顾者照顾负担的影响

目的:分析应对方式对新近确诊肺癌患者家庭照顾者照顾负担的影响.方法:采集127例肺癌患者及127名各自家庭照顾者的一般和临床信息;并对家庭照顾者进行简易应对量表(BCS)、照护者负担量表(CBI)评估;分析应对方式与照顾负担的关系.结果:入组的肺癌家庭照顾者CBI总分为(36.39±13.89)分;IV期肺癌患者的家庭...     

社区脑卒中患者处理能力及主要照顾者的照顾能力

背景 脑卒中是造成人类死亡和残疾的主要疾病之一,我国卫生部已把康复作为社区卫生服务六位一体功能之一,实施社区康复、家庭康复已势在必行。 目的 通过对社区脑卒中患者自理能力及主要照顾者照顾能力现状的调查,分析其相关影响因素,为制定系统化、标准化、个性化和家庭化的护理方案,完善我国社区康复培训模式,提高脑卒中患者生活质量提供依据。 设计,时间和单位 于2009年1月～2009年4月对上海某两个社区的研究对象进行描述性研究。 对象 上海某两个社区病程在6个月～2年的脑卒中患者60名。 方法 方便抽样法。描述性研究。应用SPSS11.5软件处理数据。 主要观察指标 对研究对象的一般资料、疾病情况、康复训练情况、自理能力及照顾者照顾能力情况进行调查评定。 结果 63.3%脑卒中患者自理能力水平中等,只有36.7%处于高等;照顾者的照顾水平5.0%处于低等,51.7%处于中等,仅43.3%处于高等;参加过社区康复训练的脑卒中患者人数为28名（46.7%）,从未参加过社区康复训练的人数为32名（53.3%）;患者的自理能力与年龄、病程、文化程度、收入、是否参加过康复训练等具有相关性。 结论 社区脑卒中患者自理能力及主要照顾者照顾能力不容乐观,参加康复训练的普及率不高,需加强康复训练的指导。     

脑卒中患者家庭护理人员的负担及影响因素调查

目的探讨脑卒中患者家庭护理人员承受的负担及影响因素,为改善家庭护理质量提供依据。方法采取回顾分析的方法收集156名脑卒中患者及家庭护理人员的一般资料,并分别对二者进行问卷调查,分析脑卒中患者家庭护理人员负担来源及影响因素。结果脑卒中患者家庭护理人员具有较高负担分数,进一步分析提示与脑卒中患者ADL、护理人员年龄、职业状况、与患者社会关系、照顾年限、每天照顾时间显著相关(P<0.05)。结论临床工作中要重视脑卒中患者家庭护理人员负担,帮助其提高相关知识和技巧,可以有效提高患者和护理人员的生活质量。     

脑卒中吞咽障碍患者疾病病耻感与主要照顾者负担的关系：家庭复原力和个体复原力的链式中介效

目的 分析家庭复原力和个体复原力在脑卒中吞咽障碍患者疾病病耻感和主要照顾者 照顾负担之间的中介效应。方法 采用便利抽样法,选择 2022 年 12 月— 2023 年 8 月于新疆医科大学 第一附属医院康复医学科住院的 235 例脑卒中吞咽障碍患者及其主要照顾者作为研究对象。采用疾病 病耻感量表（SSCI）、个体复原力量表（CD-RISC-10）、照顾者负担量表（ZBI）及家庭复原力量表（WFRQ-R-CHI）对脑卒中吞咽障碍患者的心理状态、个体复原力及其主要照顾者的照顾负担情况及家庭复原力进 行调查。采用Spearman 相关分析患者的病耻感状态、个体复原力、主要照顾者负担及家庭复原力的相关 性。采用Process V4.1插件中的Model 6和Amos软件构建链式中介模型。结果 脑卒中吞咽障碍患者主 要照顾者的 ZBI 得分为 50（42,59）分,处于中度负担水平。患者的 SSCI 得分为 87（72,95）分。Spearman 相关分析显示,脑卒中吞咽障碍患者疾病病耻感与照顾者负担呈正相关,与家庭复原力和个体复原力 呈负相关,照顾者负担与家庭复原力和个体复原力呈负相关,家庭复原力与个体复原力呈正相关（均P＜ 0.01）。家庭复原力和个体复原力在脑卒中吞咽障碍患者疾病病耻感和照顾者负担中起链式中介效应, 占总效应量的 69.04%。结论 降低患者疾病病耻感可减轻照顾者负担,同时也可从增强脑卒中吞咽障 碍患者的家庭复原力和个体复原力的角度出发,探索减轻脑卒中吞咽障碍患者主要照顾者负担的干预 方案。     

Changes in caregiver burden among informal caregivers of stroke patients in Mongolia

Background: Modern therapeutics and health care improvements prolong stroke patients’ survival; however, the degree of disability remains high. Stroke survivors often require caregivers, particularly in the first year after the onset of the stroke. Longitudinal assessment of and factors associated with caregiver burden (CGB) among caregivers of stroke patients has been scarcely discussed. This study aimed to define the changes in CGB in the first year of caregiving among the caregivers of stroke patients and to identify associated factors.

Methods: A prospective, multi-centered observational study was conducted in nine public hospitals in Mongolia. We used the Montgomery CGB Scale for assessing CGB, and repeated the assessment after 1 year. Stroke patient characteristics were included in the analyses. Multinomial logistic regressions were conducted to analyze changes in CGB.

Results: A paired t-test analysis revealed that demand burden increased (from 12.61 to 11.50, p = 0.034), whereas stress burden decreased (from 10.69 to 11.60, p = 0.016). Although objective burden decreased, the difference was not significant. Factors associated with these changes in CGB were the caregiver’s marital status, the caregiver’s relationship with the patient, financial difficulties, and the patient’s sex and dependency.

Discussion: The information on factors predicting changes in CGB in the first year of caregiving provided in this study suggests that social or financial support can assist in reducing CGB among the caregivers of post-stroke patients.     

Assessment of caregiver burden in patients undergoing in- and out-patient neurosurgery

The objective of this study is to describe the caregiver burden, as well as the financial burden among caregivers after inpatient and outpatient neurosurgical patients. In this single center, observational study, adult patients undergoing elective inpatient or outpatient neurosurgery (supratentorial tumor resection or lumbar microdiscectomy) and his/her caregiver were recruited for the study. Bakas Caregiving Outcome Scale (BCOS) was used to assess caregiver burden and data was collected from preoperative period until post-operative day (POD) 30. Cost burden was assessed by a cost diary from day of surgery till POD 7. Forty-eight patient-caregiver pairs (21 inpatient craniotomies, 7 outpatient craniotomies, and 20 outpatient microdiscectomies) completed the study. BCOS values were in the negative impact range (<60) on POD1 in craniotomy group and improved to positive impact range (>60) after POD3. Median BCOS score remained at 60 in outpatient microdiscectomy. 56% of caregiver had at least 1 day of loss of income and 20% lost income throughout first 8 days. Median Cost (in Canadian dollars) associated with caregiving ranged from C$57 to C$250 amongst different groups. We concluded that caring for patients after craniotomy is psychologically demanding which leads to an increase in caregiver burden. In addition, there is a cost burden for the care givers in the form of missed workdays and additional direct expenses. Further studies are needed to recognize this problem and address the burden among the caregivers in the neurosurgical population.     

缺血性脑卒中患者远期抑郁症状的发生率及相关因素分析

目的探讨首发缺血性脑卒中(IS)偏侧肢体功能障碍患者远期抑郁症状(DS)的发生率及影响因素。方法前瞻性研究连续入选商丘市第一人民医院神经内科2012-11—2013-07收治的首发IS偏侧肢体功能障碍患者126例,入组后收集患者一般资料并采用美国国立卫生研究院卒中量表(NIHSS)、改良Rankin Scale(MRS)评分进行评估,发病后2~3a采用NIHSS、MRS评分、Barthel指数(BI)、脑卒中专用生活质量量表(SS-QOL)、汉密尔顿抑郁评分量表(HDRS)再次随访。通过单因素分析筛选出与远期抑郁症状(DS)具有显著性联系的因素后,使用非条件Logistic回归分析DS的影响因素。结果首发IS偏侧肢体功能障碍患者中远期抑郁症状发生率38.6%(44/114),其中轻、中、重度分别占19.3%(22/114)、11.4%(13/114)、7.9%(9/114)。多因素非条件Logistic回归分析结果显示,首发IS偏侧肢体功能障碍患者远期DS的影响因素包括文化程度(OR=2.847,95%CI=1.241~6.532)、BI(OR=0.763,95%CI=0.648~0.916)、SS-QOL评分(OR=0.970,95%CI=0.937~0.989)。且轻、中、重度抑郁症状患者的远期BI评分(F=29.426,P0.01)和SS-QOL评分(F=21.379,P0.01)的总体均数不同。结论 IS偏侧肢体功能障碍患者远期DS的危险因素为文化程度高,保护因素为远期BI评分高、生活质量高。其中远期BI评分、SS-QOL评分越低,IS偏侧肢体功能障碍患者的远期抑郁症状越重。日常生活能力的恢复及生活质量的提高等可能是改善IS偏侧肢体功能障碍患者远期抑郁症状的重要措施。     

The burden of distress in caregivers of elderly demented patients and its relationship with coping strategies

Objective  Previous studies have shown that taking care of elderly, demented patients carries a high cost to caregivers’ health, and is associated with negative consequences for physical and mental health. The aim of this study is to investigate which socio-demographic and clinical variables are significantly associated with higher levels of distress in caregivers, and the relationship between caregivers’ levels of distress and the coping strategies they adopt. Patients and participants  The study samples 112 caregivers of demented patients, consecutively admitted to the Department of Neurology of San Raffaele-Turro Hospital (Milan, Italy). Measurements and results  Caregivers were asked to complete the CBI and the COPE. Caregivers with the highest levels of distress are characterised by an impaired physical health status. Avoidance coping may represent a risk factor associated with higher levels of distress; conversely, an active and problem-focused approach to stressful situations may act as a protective factor.     

The role of mind theory in patients affected by neurodegenerative disorders and impact on caregiver burden

BackgroundTheory of Mind (ToM) is defined as the ability to understand mental and emotional state. This ability is assessed also in neurodegenerative disease. Few studies have investigated the impact that social cognition of patients could have on caregiver burden. The aim of this study was to investigate a possible correlation in level of social cognition impairment between patients with different neurodegenerative disorders and their caregivers with possible impact on caregivers burden.Methodswe enrolled 48 patients with dementia divided in different groups: Fronto-Temporal Dementia (FTD), Alzheimer Disease (AD), and Mild Cognitive Impairment (MCI) and also the three groups of their respective caregivers. All subjects were submitted to ToM tests, and the caregiver groups also to Caregiver Burden Inventory (CBI) to evaluate level of burden.ResultsOur results showed that ToM was more impaired in FTD patients and in their caregivers In addition, FTD group showed more impaired performances in tasks related to emotional skills.ConclusionsWe suggested that ToM impairment of patients are related to ToM impairment of caregivers with differences of scores in caregiver groups. The caregiver difficulties to understand, attribute and describe emotional and mental states of their relatives develop distress and inability in burden management and disorders relative to neurodegenerative disease.     

进展性脑梗死的影响因素分析

目的 探讨进展性脑梗死的影响因素.方法 回顾分析153例进展性脑梗死患者的临床资料,对其血糖、血压、血脂、纤维蛋白原、颈动脉血管、发热、白细胞、C反应蛋白与146例完全性脑梗死比较,并进行统计学处理.结果 进展性脑梗死组血糖增高,收缩压水平下降,甘油三酯、胆固醇、纤维蛋白原水平、颈动脉血管狭窄、发热、白细胞、C反应蛋白水平显著高于完全性脑梗死组.结论 进展性脑梗死是多种因素多种机制共同作用的结果 ,采取积极的干预对策可以提高疗效.     

脑卒中后肺炎危险因素分析

目的：探讨脑卒中后发生肺炎的危险因素。方法收集2013‐01—2014‐04我院收治的脑卒中患者170例,回顾分析其临床资料,总结脑卒中后肺炎危险因素。结果本组170例患者中,31例发生肺炎,发生率18.2％。经多变量Lo‐gistic回归分析显示,患者的年龄、性别、机械通气、NIHSS评分以及吞咽困难均是脑卒中后肺炎的独立危险因素（P＜0.05）。结论老年、男性、长期机械通气、吞咽困难以及NIHSS评分均与脑卒中后肺炎的发生密切相关,早期评估脑卒中后肺炎发生风险并针对危险因素进行干预,有利于改善临床预后。     

Psychological health of caregivers and association with functional status of stroke patients

Objective: Stroke does not only affect the physical state of patients but also the emotional state of their relatives, most effectively their caregivers. The study aims to examine the mood of caregivers experienced with care for patients with stroke who are highly dependent on the assistance and also to establish the relationship between the emotional state of caregivers and the severity of disability of the patients.

Methods: This study contained a total of 76 patients with sufficient cognitive functions and severe physical disabilities with hemiplegia caused by a cerebrovascular accident and their caregivers and 94 controls. The functional state of patients was assessed by the Barthel Index (BI). Furthermore, emotional state of the caregivers was assessed by the Hospital Anxiety and Depression Scale (HADS) and their life quality was assessed by the SF36 Health Survey.

Results: The mean anxiety (9.73 ± 4.88) and depression rates (9.81 ± 5.05) in the caregivers were significantly higher than those in controls (p<0.001, respectively). Significant impairments were observed in both their mental and physical health. Regression analysis also showed a significant negative correlation between the BI scores and the HADS scores.

Conclusion: Caregivers had an impaired emotional state and the level of their anxiety was associated with the severity of functional disability of the patients. Therefore, the support provided to the caregiver might be influential on the functional recovery of the patients.