脑卒中偏瘫患者的居家遵医行为及其影响因素分析

Analysis of home compliance behaviors and influencing factors in patients with stroke hemiplegia

目的观察脑卒中偏瘫患者的居家遵医行为,并分析其影响因素,为提高患者主动健康管理行为提供参考。方法随访了解脑卒中偏瘫患者出院后6个月内的遵医行为,评价并比较是否遵医嘱患者间的临床资料和偏瘫肢体功能恢复情况、生活能力、生存质量、家庭支持度、社会支持度、疾病不确定感和医学应对方式,统计随访期间患者的并发症情况。采用Logistic回归分析患者出院后居家期间遵医行为的影响因素。结果随访期间,83例患者出院后居家期间遵医嘱服药、定期复诊、康复训练、合理饮食、规律作息的比例分别为93.98%、85.54%、81.93%、77.11%、75.90%;5项均遵守者51例(61.45%)为遵医组,共出现尿路感染和压疮各1例;余32例不遵医者共出现尿路感染2例、压疮4例,2组并发症发生率差异有统计学意义(χ^(2)=4.964,P=0.026)。Logistic回归分析显示,患者的文化程度和家庭支持度、医护上门随访是脑卒中偏瘫患者出院后居家期间遵医行为的影响因素(P<0.05)。结论脑卒中偏瘫患者出院后居家期间遵医嘱服药、定期复诊、康复训练的比例较高,上门随访、家庭支持度可提高脑卒中偏瘫患者的居家遵医行为。

Objective To observe the home medical compliance behavior of stroke hemiplegic patients and analyze its influencing factors,in order to provide reference for improving patients'proactive health management behavior.Methods Follow-up was conducted to understand the medical compliance behavior of stroke hemiplegic patients within 6 months after discharge,evaluate and compare the clinical data,functional recovery of paralyzed limbs,life abilities,quality of life,family support,social support,disease uncertainty,and medical coping strategies among patients who complied with medical advice and those who did not.The incidence of complications during the follow-up period was statistically analyzed.Logistic regression analysis was used to identify the influencing factors of medical compliance behavior during the post-discharge home period.Results During the follow-up period,the proportions of 83 patients who complied with medication,regular follow-up visits,rehabilitation training,a balanced diet,and regular daily routines at home after discharge were 93.98%,85.54%,81.93%,77.11%,and 75.90%,respectively.51 cases(61.45%)who complied with all five items were set as compliance group,with only one case each of urinary tract infection and pressure ulcer occurring in this group.The remaining 32 non-adherent cases had two cases of urinary tract infection and four cases of pressure ulcers,and there was a statistically significant difference in the incidence of complications between the two groups(χ^(2)=4.964,P=0.026).Logistic regression analysis showed that the patient's education level,family support and medical home follow-up were the influencing factors of compliance behaviors of patients with stroke hemiplegia during home period after discharge(P<0.05).Conclusions Stroke hemiplegic patients show a high level of compliance with medication,regular follow-up visits,and rehabilitation training during the home period after discharge.Home follow-up and family support can enhance the medical compliance behavior of patients with stroke hemiplegia.