医院到家庭连续护理模式对持续植物状态出院患者的效果

目的创建医院到家庭护理干预方案,探讨其对持续植物状态出院患者的效果。方法选择2011年6月-2013年6月浙江省乐清市某三级乙等医院神经外科持续植物状态的出院患者47例,按照不同社区分为对照组（23例）和干预组（24例）。对照组采用常规出院康复指导及随访,干预组在常规出院指导的基础上建立一个微信群,通过网络访视实施医院到家庭持续护理干预,干预措施包括出院前的健康课程教育、出院前护理评估,出院后的电话随访、网络访视、家庭随访。1年后对两组患者的并发症发生率和卫生服务利用率进行统计,并比较两组间差异。结果干预组患者出院后1年感染的发生率为25.00%;胃肠道症状发生率为16.67%;机械性症状发生率为25.00%;压疮发生率为12.50%;误吸发生率为4.17%;肢体并发症发生率为12.50%;癫痫发生率为4.17%。对照组患者出院1年感染的发生率为62.22%;胃肠道症状、机械性症状发生率均为47.83%;压疮发生率为39.13%;误吸发生率为30.43%;肢体并发症发生率为43.48%;癫痫发生率为39.13%。两组并发症发生率比较,差异有统计学意义（P〈0.05）。两组患者再次住院率和急诊访问率比较,差异均无统计学差异（P〉0.05）,但干预组的门诊访问率显著高于对照组（P〈0.01）。结论医院到家庭连续护理模式对降低持续植物状态出院患者的并发症发生率效果明显。

Evaluation on the hospital to home continuous nursing mode for discharge patients in persistent vegetative state

Objective To create the hospital to home care intervention programs and investigate its effect on the persistent vegetative state patients discharged. Methods 47 cases of discharged patients with persistent vegetative state who were from the Department of Neurosurgery were selected in a hospital of Yueqing City in Zhejiang Province from June 2011 to June 2013, and were divided into two groups of control group（23 cases） and intervention group（24 cases） according to different communities. Patients in the control group were given routine rehabilitation guidance discharge and follow-up, and the network visit by establishing a micro-channel group were given to the intervention group on the basis of conventional discharge guidance. Interventions were including health education course and nursing assessment before discharged, telephone follow-up, the network visit, family follow-up visit after discharged. The incidence of complications and health services utilization were analyzed, and the difference between the two groups was observed 1 year later. Results The intervention group patients 1 year after discharged, infection rate was 25.00%, gastrointestinal symptoms rate was 16.67% the mechanical symptoms occurrence rates was 25.00%, pressure sore rate was 12.50%, aspiration rate was 4.17%, limb complications rate was 12.50%, epilepsy rate was 4.17%. The control group patients 1 year after discharged infection rate was 62.22%, gastrointestinal symptoms rate was 47.83%, mechanical symptoms rate was 47.83%, the pressure sore rate was 39.13%, aspiration rate was 30.43%, limb complications rate was 43.48%,epilepsy rate was 39.13%. There was significant difference between two groups（P〈0.05）. Two groups of patients with hospital readmission rate and emergency access rate had no significant differences（P〉0.05）, but out-patient visit rate in the observation group was significantly higher（P〈0.01）. Conclusion The hospital to home continuous nursing mode is effective to reduce the incidence of complication