开展以家庭为中心的脑卒中护理

综述了国内外近年来在实行以家庭为中心的脑卒中护理方面取得的进展，指出其必要性及其优势，以及开展此护理护士需要具备的知识与技能。     

急性重症脑卒中患者的监护及其意义

在神经内科常规护理的基础上 ,对 36例重症脑卒中患者中的 14例施行监护 ,另 2 2例作为对照。两组患者的一般情况包括年龄、开始治疗时间、既往病史评分和入院时的 NIHSS评分及 Glasgow评分均无显著差别 (P >0 .0 5 )。结果发现 ,监护组的死亡率为 7.14% ,较对照组 18.18%有显著降低 (P <0 .0 1) ;监护组所需住院治疗时间为 (2 0 .34± 2 .45 ) d,与对照组 (32 .2 4± 3.2 3) d相比明显缩短 (P <0 .0 5 ) ;虽然两组患者在入院后 2周 HIHSS评分无显著差异(P >0 .0 5 ) ,但 4周后两组 NIHSS评分相差显著 (P <0 .0 1) ,提示监护组有着较好预后。以上结果表明 ,对重症脑卒中患者施行监护有着比较重要的意义     

Use of Care by Home-dwelling Stroke Patients during Three Years following Hospital Discharge

Of 82 stroke survivors who had been discharged from hospital, 49 were still living at home after a three-year period. Thirty-three of these patients formed the population of the present study of the use of care at home. Sixty-one percent had received professional care and 88% had received family care. Although their overall functional status indicated only mild handicaps, after three years patients still reported a large number of disabilities and problems. The average weekly amount of family care was 37 h, and many family carers experienced a high burden of care and had emotional problems coping with the patients' disabilities. Concerning factors related to the use of care, in spite of the relatively small number of study patients, some interesting hypotheses can be advanced.     

脑卒中吞咽障碍患者功能训练与心理护理

目的 :探讨心理护理在脑卒中吞咽障碍患者功能训练中的作用。方法 :6 0例脑卒中吞咽功能障碍患者随机分为心理组和对照组各 30例 ;2组均接受吞咽功能训练 ,心理组同时给予心理护理。结果 :经过 3个月的治疗 ,心理组吞咽功能的优良率明显高于对照组 (P <0 .0 5 )。结论 :对脑卒中吞咽障碍患者在开展康复功能训练的同时结合心理治疗 ,效果更为显著     

Functional Status of Stroke Patients in Long-Term Care

Thirty persons who had remained in long-term care for one year or more post-stroke were assessed with respect to motor function, cognitive, perceptual, and communication ability and ADL capacity. Before the stroke they had lived an independent life, although 40% suffered from cardiovascular disease. At the follow-up, all patients had severe impairments due to the brain damage. None could walk or stand independently, ten could not call for help or attract attention in any way, and 13 could not take part in a conversation. Eleven patients had severe pain in spite of treatment with analgesics. Pain treatment and training methods that can reduce dependence and improve the quality of life for patients like these need to be developed. More appropriate assessment instruments for this patient group have to be constructed to make evaluation of training and care possible.     

维吾尔族脑卒中患者实施卒中单元疗效观察

目的探讨卒中单元对维吾尔族脑卒中患者的疗效及预后。方法比较普通病房的153例维吾尔族脑卒中患者与卒中单元的160例维吾尔族脑卒中患者的治疗效果。结果在卒中单元治疗的患者死亡率低于普通病房的患者,疗效优于普通病房的患者(P<0.05～0.01)。结论对维吾尔族脑卒中患者实施卒中单元管理模式具有良好的治疗效果。     

脑卒中患者家庭护理质量量表的信、效度研究

目的:修订编制“脑卒中患者家庭护理质量量表”,检验其信、效度。方法:以台湾“家庭照护品质量表”为基础修订量表各维度及条目,遴选7名专家测评其内容效度。通过173例社区脑卒中患者的调查研究,检验量表的结构效度和内在一致性信度;并抽取其中的50例检验其评价者间信度。结果:形成具有5个维度、27个条目的评价量表;Cronbach α系数为0.9135,各维度α系数为0.6461～0.8170;评价者间信度为0.851。结论:修订后的量表具有良好的信度与效度,可用于评价脑卒中患者家庭护理质量。     

脑卒中患者姑息照护的研究进展

脑卒中是一种常见的致死、致残率极高的神经系统疾病。在我国,脑卒中是造成城乡居民死亡的首要原因。尽管随着现代诊疗水平的提高,病死率有所下降,但致残率仍很高,同时患者常伴有抑郁、焦虑等心理障碍。     

脑卒中失能老人康复治疗中家庭关怀度与自我感受负担的调查

目的调查脑卒中失能老人康复治疗中家庭关怀度与自我感受负担,以期为实施优质护理提供现实依据。方法2014年12月至2015年12月,便利抽样法选取在第二军医大学长征医院治疗的225例脑卒中失能老人为研究对象,采用家庭关怀度问卷和自我感受负担量表对其进行调查。结果 225例患者中,有88.00%的患者存在自我感受负担;自我感受负担总分为(32.33±1.46)分;家庭关怀度总分为(7.23±1.37)分。结论脑卒中失能老人康复治疗期间自我感受负担发生率较高,家庭关怀度普遍较低相关部门应制定相关措施提高患者的家庭关怀度,降低患者的自我感受负担。     

Nursing Interventions in Stroke Rehabilitation: A Study of Nurses' Views of Their Pattern of Care in Stroke Units

The care given to stroke patients in acute care general wards has been described as of a poor standard, with resultant poor outcomes. Systematic reviews have established the benefits of stroke units on patient, outcomes such as functional ability and mortality. The trials have also hypothesized on the reasons for such improvements. One explanation is that the establishment of an interested, enthusiastic, and specialized nursing workforce within a stroke unit improves levels of care and hence, outcomes. However, there has been no research to identify the nature of the nursing care that is provided. To identify the nursing interventions of such a work force, we asked 90 nurses in 21 stroke units about the care that they provide for stroke patients and their caregivers. Our study suggests that nursing interventions in stroke care can be discussed within the criteria and concepts of six themes—focus of care, outcomes of care, direct care, continuity of care, mode of care, and context of care. These themes are dependent on one another for the successful delivery of the care that the nurses expect to deliver. The implications of these findings for the delivery and organization of rehabilitative nursing care are discussed.     

脑卒中患者口服橄榄油的临床作用

目的：观察口服橄榄油对脑卒中患者血糖、血脂及排便的影响。方法：230例脑卒中患者均执行常规的康复科护理,并从观察日开始首次口服橄榄油30ml,此后每日清晨空腹10ml。治疗前后观察患者血糖、血脂的变化及排便情况。结果：配合口服橄榄油3个月后,230例患者与治疗前比较,总胆固醇（TC）及低密度脂蛋白（LDL—C）、甘油三脂（TG）含量及空腹血糖和餐后2h血糖均明显降低,高密度脂蛋白（HDL-C）含量升高（P〈o．05,0．01）,其中129例便秘患者,恢复正常123例（95．3％）,6例为轻度便秘。结论：大剂量（30ml）口服橄榄油对脑卒中便秘患者有快速通便作用;长期小剂量（10ml）口服橄榄油可调节血脂,降低血糖,保持大便通畅,对预防或减少脑卒中复发有较好作用。     

Nurse Care Coordination in Community-Based Long-Term Care

PURPOSE: To evaluate the clinical outcomes of a nurse care coordination program for people receiving services from a state-funded home and community-based waiver program called Missouri Care Options (MCO). DESIGN: A quasi-experimental design was used to compare 55 MCO clients who received nurse care coordination (NCC) and 30 clients who received MCO services but no nurse care coordination. METHODS: Nurse care coordination consists of the assignment of a registered nurse who provides home care services for both the MCO program and Medicare home health services. Two standardized datasets, the Minimum Data Set (MDS) for resident care and planning and the Outcome Assessment Instrument and Data Set (OASIS) were collected at baseline, 6 months, and 12 months on both groups. Cognition was measured with the MDS Cognitive Performance Scale (CPS), activities of daily living (ADL) as the sum of five MDS ADL items, depression with the MDS-Depression Rating Scale, and incontinence and pressure ulcers with specific MDS items. Three OASIS items were used to measure pain, dyspnea, and medication management. The Cochran-Mantel-Haenszel (CMH) method was used to test the association between the NCC intervention and clinical outcomes. FINDINGS: At 12 months the NCC group scored significantly better statistically in the clinical outcomes of pain, dyspnea, and ADLs. No significant differences between groups were found in eight clinical outcome measures at 6 months. CONCLUSIONS: Use of nurse care coordination for acute and chronic home care warrants further evaluation as a treatment approach for chronically ill older adults.     

急诊护理路径在急性脑卒中患者中的应用

目的探索急性脑卒中患者的有效急救护理模式,以降低致残率和病死率.方法急诊科2006年1月—2010年12月接收来自“120”的急性脑卒中患者300例,实施以时间为控制的接诊前、接诊、病情评估、急救护理、术前准备、护送至专科的护理路径;急诊护理路径从急诊科接收到120中心提供的患者信息开始,到急诊科救治结束止,要求患者到达急诊科后至专科治疗时间控制在70 min以内,即10 min内完成接诊前护理,10 min内完成病情评估及急救护理,20 min内完成医技检查,30 min内完成术前准备及护送至专科治疗护理.结果患者从接诊到确诊时间为16~22(18.50±1.66)min,从确诊到接受专科治疗时间为18~26(23.60±3.41)min,较同期文献报道缩短;致残52例,致残率为17.3%,死亡18例,病死率为6.0%,均低于文献报道.结论急诊护理路径能缩短急性脑卒中急诊救治的时间,降低患者致残率和病死率.     

实施家属健康教育对提高脑卒中患者生活质量的影响

目的 探讨对脑卒中患者家属同步实施健康教育对患者生活质量的影响.方法 选择62例脑卒中住院患者,按首次住院的先后顺序分为观察组(单号)和对照组(双号),两组患者在常规治疗的同时接受健康教育,观察组在此基础上同步实施家属健康教育.在患者入院时及入院后第8周,采用生活质量指数评定量表,分别对两组患者的生活质量进行评分并记录.结果 第8周时,观察组总体生活质量明显高于入院时及对照组,差异有统计学意义(P＜0.01).结论 对脑卒中患者家属同步实施健康教育,可提高家属的照顾水平及配合程度,提高患者的生活质量.     

老年脑卒中患者吞咽障碍的康复护理

目的探讨老年脑卒中合并吞咽障碍患者康复护理的效果。方法对17例脑卒中合并吞咽障碍的老年患者制定个体化的吞咽训练计划,进行针对性吞咽训练,观察护理前后的效果。结果经过4周康复护理,患者吞咽功能明显提高（P〈0.01）。结论脑卒中合并吞咽障碍患者康复护理可改善吞咽功能,促进疾病的早日康复。     

对175例脑卒中患者护理诊断的分析

以“护理程序”为核心的整体护理要求护士在工作中不断发现患者的健康问题,并为患者解决问题。而在专科护理中,护士如何熟练掌握和正确提出护理诊断/问题,体现专科及个体特色,是一个普遍存在,亟待解决的问题。对175例脑卒中患者的542个护理诊断进行了分析总结,指出脑卒中患者护理诊断集中分布的趋势,及其应用的局限性和对策。     

自理模式在脑卒中患者早期康复护理中的应用

目的探讨奥瑞姆（Orem）自理模式在脑卒中患者早期康复护理中的作用。方法2007年1月至2008年10月某院180例脑卒中患者,按照其病例单双号分为对照组和康复组,每组各90例。对照组仅采用整体护理与早期康复护理;康复组除了运用整体护理与早期康复护理外,还根据患者情况采用Orem自理模式中完全补偿系统、部分补偿系统、支持和教育系统。结果康复组肢体运动功能Fugl—Meyer评分较对照组明显提高[（48．11±28．07）vs（63．03±21．88）],差异有统计学意义（P〈0．01）。日常生活能力Barthel指数康复组较对照组明显提高[（51．24±19．07）vs（69.77±21．34）],差异有统计学意义（P〈0．01）。结论自理模式可提高脑卒中患者肢体运动功能及患者的日常生活活动能力,从而能够改善患者的生活质量。     

循证护理在脑卒中患者吞咽障碍康复中的应用

目的应用循证护理理念,探讨康复护理对脑卒中后吞咽障碍的疗效。方法选择2007年9月至2008年12月住院的60例脑卒中后吞咽障碍的患者,按病历单双号分成循证护理康复组和对照组,每组30例。治疗前后分别用吞咽障碍评分进行评定。结果经过2周的康复护理,循证护理康复组患者吞咽功能恢复总有效率为91.3%,对照组总有效率为72%,差异有统计学意义（P〈0.05）。结论应用循证护理方法,可促进脑卒中后吞咽障碍的康复,提高患者日常生活能力。