神经重症患者出院准备度现状与影响因素分析

Readiness for hospital discharge of patients with severeneurological disorders and its influencing factors

目的分析神经重症患者出院准备度现状及其影响因素,为患者安全出院提供借鉴资料。方法回顾性分析2017年11月至2018年10月182例神经重症患者的临床资料,总结神经重症患者出院准备度现状,分析患者的基本情况、医疗费用结算方式、入院时神经功能缺损评分、入院意识障碍、疾病类型、ICU住院时间等对神经重症患者出院准备度的影响。结果182例神经重症患者出院准备度为(7.26±1.40)分,其中,自身状况、疾病知识、出院后应对能力、可获得社会支持均分分别为(7.42±1.53)分、(7.11±1.29)分、(7.34±1.46)分、(7.20±1.38)分,出院准备度良好率为78.57%。年龄<60岁、婚姻状况良好、照顾者为配偶、医疗费用医保结算、入院时神经功能缺损评分≤15分、入院意识障碍评分≥7分、疾病类型为脑血管及神经疾病、ICU住院时间<2周、有机械通气的神经重症患者出院准备度良好率更高(P<0.05)。多因素logistic回归分析显示年龄、照顾者、医疗费用结算方式、入院时神经功能缺损评分、入院意识障碍、疾病类型、ICU住院时间为神经重症患者出院准备度的独立影响因素。结论年龄、照顾者、医疗费用结算方式、入院时神经功能缺损评分、入院意识障碍、疾病类型、ICU住院时间为神经重症患者出院准备度的独立影响因素,临床工作者应针对以上影响因素采取干预措施,提高患者的出院准备度,保证患者安全出院。

Objective To discuss the readiness for hospital discharge of patients with severe neurological disorders and its influencing factors.Methods The clinical data of 182patients with severe neurological disorders from November 2017to October 2018in our hospital were retrospectively analyzed,the status of readiness for hospital discharge was summarized and it′s influencing factors were analyzed.Results In this group of 182 patients with severe neurological disorders,the average score of discharge readiness was 7.26±1.40,and the scores for phisical condition,disease knowledge,post-discharge self-coping ability and social support were 7.42±1.53,7.11±1.29,7.34±1.46and 7.20±1.38,respectively.The well-prepared rate for discharge was 78.57%,which were higher among patients aged<60years old,with happy marriage,spouse as caregiver,with medical insurance,with neurological deficit score of 15and lower at admission,Glasgow coma score≥7,with cerebrovascular and neurological diseases,length of ICU stay<2weeks and with mechanical ventilation.Multivariate logistic regression analysis showed that age,caregiver,medical expenses payment method,neurological deficit score at admission,consciousness disorder at admission,disease type and length of ICU stay were independent influencing factors for discharge readiness of patients with severe neurological disorders.Conclusions Age,caregiver,medical expenses payment method,neurological deficit score at admission,disturbance of consciousness at admission,disease type and length of ICU stay are independent influencing factors for discharge readiness of patients with severe neurological disorders.Therefore,interventions targeting different influencing factors should be adopted by health providers to improve patient′s readiness for hospital discharge and ensure the safe discharge of patients.