社区分级康复管理模式对脑卒中后居家患者功能恢复的效果评价

目的 探讨专科医院-社区-家庭的分级康复管理模式的使用效果,对社区规范化管理的脑卒中患者开展评价。 方法 选取2014年3月—2015年2月于上海专科医院住院经CT或磁共振确诊的脑卒中患者共计100例,随机分为康复组50例和对照组50例。康复组给予专科医院病房-社区卫生服务中心-家庭的三级脑卒中康复:(1)初级康复:急性期时在医院的治疗;(2)二级康复:社区卫生服务中心(站)对患者出院后培训3个月,至少2次/周,40 min/次,同时对脑卒中患者发放康复锻炼宣传手册;(3)三级康复:社区的康复医师到患者的家庭进行康复训练9个月,最少1次/2周,30 min/次。社区康复医师同时需教会患者家属正确的护理方法,非治疗时间要求患者在家属的帮助下完成护理和康复训练,1~2次/d。对照组继续进行一般化管理。应用康复运动功能评定测量表(Fugl-Meyer)8]、改良Barthel指数、功能独立性评定法(FIM)、生活质量量表(SS-QOL量表)评定患者的治疗效果。 结果 康复治疗前,2组Fugl-Meyer评分、改良Barthel指数和FIM评分差异无统计学意义(P>0.05)。康复治疗后6个月和12个月,康复组Fugl-Meyer评分、改良Barthel指数和FIM评分均明显高于对照组,差异有统计学意义(P<0.01)。康复治疗后12个月,康复组SS-QOL得分高于对照组,差异有统计学意义(P<0.01)。 结论 通过规范化管理,促进脑卒中患者自理能力恢复,对提高生活质量有很好的作用,具备良好的社会经济效果。 

Effectiveness evaluation of community-based rehabilitation management model on functional recovery of homebound stroke patients

Objective To explore the application effect of the hierarchical rehabilitation management mode of the community health service organization of the specialized hospital ward and a community health service institution in the community standardized management of the stroke patients. Methods A total of 100 acute apoplexy patients, diagnosed by CT or MRI from March, 2014 to February, 2015 in specialist hospital, was divided randomly into the rehabilitation group (n=50) and control group (n=50).The patients in the rehabilitation group were given the three-level management:(1) Firstlevel rehabilitation included acute stage treatment in the specialist hospital. (2) Second-level rehabilitation included three month rehabilitation training in community health service station for 40 minutes, 2 times a week at least;and the patients were given brochure on rehabilitation training. (3) Third-level rehabilitation included nine month home rehabilitation training for 40 minutes, once in two week;and during non-treating times, the patients were asked to do rehabilitation once or twice a day under the help by family members or nursing staff who had learnt the correct method from the doctor, the control group continued to carry out the general management. Results Fugl-Meyer motor function evaluation, FIM evaluation and modified Barthel index were used to evaluate the therapeutic effect of the 6 months and 12 months after the selection.Before the intervention, the two groups of Fugl-Meye, modified FIM Barthel index score, the difference was not statistically significant (P > 0.05).Intervention for 6 months and 12 months, the intervention group Fugl-Meye, improved Barthel and FIM scores, significantly higher than those in the control group (P < 0.01). Conclusion In the community of grading rehabilitation management mode of stroke community norms of management, the function of stroke patients recovery plays a good promoting role in improving the quality of life, with better social and economic effects.