新型医护康患一体化模式在首发脑卒中偏瘫患者中的应用研究

Application of new integrated model of medical care, health care and patient in first-episode stroke patients with hemiplegia

目的观察新型医护康患一体化模式在首发脑卒中偏瘫患者护理康复中的应用效果,为康复方案的制定提供参考。方法选择2020年9月至2021年9月温州市中心医院接诊的首发脑卒中并发偏瘫患者60例作为研究对象,按随机数字表法将患者分为观察组和对照组。对照组接受常规护理康复干预(包括传统的神经内科护理、常规用药和常规康复训练);观察组接受新型医护康患一体化管理(实施步骤包括入院评估和宣教、早期康复指导、医护康患共同为患者制定个性化康复护理方案、优化出院流程)。比较两组患者干预前和干预30 d后康复依从性、美国国立卫生研究院卒中量表(NIHSS)评分、肢运动功能评分及日常生活活动能力(ADL)评分的差异,并分析其对临床护理的满意度。结果干预30 d后,两组患者身体锻炼依从性评分、锻炼效果监督依从性评分、主动寻求建议依从性评分、肢体运动功能评分、ADL评分均明显高于干预前〔对照组:身体锻炼依从性评分(分)为20.27±2.46比14.48±2.03,锻炼效果监督依从性评分(分)为7.49±1.65比5.13±1.14,主动寻求建议依从性评分(分)为8.07±1.38比5.49±1.13,上肢运动功能评分(分)为35.76±4.31比23.45±3.52,下肢运动功能评分(分)为18.14±3.22比12.34±2.72,ADL评分(分):68.38±6.74比54.23±5.35;观察组:身体锻炼依从性评分(分)为28.09±2.74比14.76±1.89,锻炼效果监督依从性评分(分)为9.08±2.34比5.39±1.29,主动寻求建议依从性评分(分)为10.08±1.67比5.53±1.22,上肢运动功能评分(分)为48.25±5.44比23.24±3.78,下肢运动功能评分(分)为26.27±4.13比12.89±2.44,ADL评分(分)为78.62±7.46比54.84±5.81,均P<0.05〕,NIHSS评分(分)均明显低于干预前(对照组:18.23±3.09比24.64±4.37,观察组:9.24±2.58比24.49±4.33,均P<0.05);且观察组上述指标的变化明显优于对照组〔身体锻炼依从性评分(分):28.09±2.74比20.27±2.46,锻炼效果监督依从性评分(分):9.08±2.34比7.49±1.65,主动寻求建议依从性评分(分):10.08±1.67比8.07±1.38,NIHSS评分(分):9.24±2.58比18.23±3.09,上肢运动功能评分(分):48.25±5.44比35.76±4.31,下肢运动功能评分(分):26.27±4.13比18.14±3.22,ADL评分(分):78.62±7.46比68.38±6.74,均P<0.05〕。观察组护理满意度明显高于对照组〔96.67%(29/30)比76.67%(23/30),P<0.05〕。结论新型医护康患一体化能提高首发脑卒中偏瘫患者康复锻炼的依从行为,改善神经、肢体运动功能,提高护理满意度。

Objective To observe the application effect of the new model of integration of medical care,health care and patient in the nursing and rehabilitation of patients with first stroke hemiplegia,and to provide reference for the formulation of rehabilitation programs.Methods A total of 60 patients with first-episode stroke complicated with hemiplegia admitted to Wenzhou Central Hospital from September 2020 to September 2021 were selected as research objects.All patients were divided into observation group and control group according to random number table method.The patients in the control group received routine nursing rehabilitation intervention(including traditional neurology nursing,routine medication and routine rehabilitation training),and the patients in the observation group received new integrated management of medical care,health care,and patient(implementation steps included admission assessment and education,early rehabilitation guidance,medical care and patient jointly develop personalized rehabilitation nursing plan for patients,optimize discharge process).The rehabilitation compliance,National Institute of Health stroke scale(NIHSS)score,limb motor function score,and activity of daily living(ADL)score were compared before intervention and 30 days after intervention,and the patients'satisfaction with clinical nursing was compared.Results After 30 days of intervention,the physical exercise compliance score,exercise effect supervision compliance score,active suggestion seeking compliance score and limb motor function score and ADL score of both groups were significantly higher than before intervention(control group:physical exercise compliance score was 20.27±2.46 vs.14.48±2.03,exercise effect supervision compliance score was 7.49±1.65 vs.5.13±1.14,actively seeking advice compliance score was 8.07±1.38 vs.5.49±1.13,upper limb motor function score was 35.76±4.31 vs.23.45±3.52,lower limb motor function score was 18.14±3.22 vs.12.34±2.72,ADL score was 68.38±6.74 vs.54.23±5.35;observation group:physical exercise compliance score was 28.09±2.74 vs.14.76±1.89,exercise effect supervision compliance score was 9.08±2.34 vs.5.39±1.29,actively suggestion seeking advice compliance score was 10.08±1.67 vs.5.53±1.22,upper limb motor function score was 48.25±5.44 vs.23.24±3.78,lower limb motor function score was 26.27±4.13 vs.12.89±2.44,ADL score was 78.62±7.46 vs.54.84±5.81,all P<0.05),the NIHSS score was lower than that before intervention(control group:18.23±3.09 vs.24.64±4.37,observation group:9.24±2.58 vs.24.49±4.33,both P<0.05).The changes of the above indexes in the observation group were significantly better than those in the control group(physical exercise compliance score:28.09±2.74 vs.20.27±2.46,exercise effect supervision compliance score:9.08±2.34 vs.7.49±1.65,actively suggestion seeking compliance score:10.08±1.67 vs.8.07±1.38,NIHSS score:9.24±2.58 vs.18.23±3.09,upper limb motor function score:48.25±5.44 vs.35.76±4.31,lower limb motor function score:26.27±4.13 vs.18.14±3.22,ADL score:78.62±7.46 vs.68.38±6.74,all P<0.05).The nursing satisfaction of the observation group was significantly higher than that of the control group[96.67%(29/30)vs.76.67%(23/30),P<0.05].Conclusion The new integrated model of medical care,health and patient can significantly improve the compliance of rehabilitation exercise,improve the nerve and limb motor function,and improve nursing satisfaction.