缺血性脑卒中患者出院后延续性护理干预的效果研究

目的：探讨接受出院后护理干预的缺血性脑卒中患者遵医行为变化及卒中危险因素的控制情况。方法：采用自身实验前后对照设计。对符合入选条件的66例患者，按照Essen评分分级设计个体化随访干预方案，干预内容包括根据患者情况进行针对性的脑卒中健康教育，督促患者按时复诊，定期监测血压、血糖等指标，干预时间为1年。比较干预前后患者遵医行为的情况以及相关危险因素的控制情况。结果：接受出院后护理干预的66例脑卒中患者服药依从性较好，超重和肥胖率较干预前有下降的趋势（45.4%vs 42.4%），血压、血糖控制率较干预前有升高的趋势（分别为84.8%vs 92.4%，81.8%vs 83.3%）。血压、血糖、血脂低于干预前水平（P〈0.05），复发和病死率均为0。结论：缺血性脑卒中患者出院后延续性护理干预研究中的研究对象的遵医行为和卒中危险因素控制水平较好，复发率和病死率非常低。

Effects of transitional care intervention on risk factors control for recurrence in ischemic stroke patients

Objective：To explore the effect of transitional care intervention on behavior compliance and risk factors control for ischemic stroke patients who discharged from hospital. Methods：It was a before-after designed study. A one-year nurse-led transitional care intervention was implemented to 66 new ischemic stroke patients who discharged from the hospital. The intervention included the following components：health education about stroke risk factors control, encouraging regular follow-ups, blood pressure and blood tests （e.g., blood sugar） monitoring. The intervention plan was modified according to patients Essen’s classiifcation. T-tests and Chi-Square tests were used to analyze the data. Results：Sixty-six ischemic stroke patients demonstrated good behaviors compliance. Although no statistically significant changes were identified, the number of the participants with overweight and obesity decreased （45.4%vs 42.4%）;and controlled rates of blood pressure and blood sugar showed a trend of increase （84.8%vs 92.4%, 81.8%vs 83.3%, respectively）. The levels of blood pressure, blood glucose, blood lipid statistically signiifcantly decreased （P〈0.05）. No recurrence and death occurred during the study period. Conclusion：The patients in this study showed compliant behaviors and better risk factors control of stroke, and the recurrence and mortality rate were relatively low.