一线城市脑卒中患者社区康复现况及需求分析

Health Condition and Demand for Community-based Rehabilitation among Stroke Patients in First-tier Cities

目的了解社区脑卒中患者康复期的健康问题,探讨其社区康复需求。方法 2011年8—12月,采用一般状况调查表、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、功能综合评定量表(FCA)调查上海某社区团队所管辖的脑卒中患者124例,回收有效问卷116份,统计并分析患者的慢性病患病情况、心理健康状况及功能受损情况。结果 116例脑卒中患者中93例(80.2%)有高血压,52例(55.9%)随机血压控制不合格;69例(59.5%)有高血脂,26例(22.4%)有心脏疾病,16例(13.8%)有2型糖尿病,12例(10.3%)有糖耐量受损。116例脑卒中患者的HAMA评分为(23±7)分,可能有焦虑23例(19.8%),肯定有焦虑30例(25.9%),有明显和严重焦虑7例(6.0%);HAMD评分为(21±6)分,可能有抑郁26例(22.4%),肯定有抑郁6例(5.2%),无严重抑郁患者。FCA评定:躯体功能总得分为(50.9±21.7)分,认知功能总得分为(20.1±6.8)分,FCA评定总得分为(71.1±25.4)分。结论脑卒中患者面临的最严重的健康问题是慢性病和以抑郁、焦虑为主的心理问题。社区"三级康复"应加强功能康复和心理干预,加强脑卒中患者的血压、血糖和血脂的监测、控制和随访,降低脑卒中复发率。

Objective To analyze the health problems during recovery period of stroke among patients in community and their demand for community-based rehabilitation.Methods A total of 116 patients with stroke in community were included.The questionnaire on general condition,Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),and functional comprehensive assessment(FCA) were applied to investigate their physical as well as psychological health condition and their daily functions.Results Up to 80.2%(93 /116) of stroke patients suffered from high blood pressure,the random blood pressure control failure rate was as high as 55.9%(52 /93);59.5%(69 /116) patients were with hyperlipemia;22.4%(26/116) were with cardiovascular disease;13.8%(16/116) were with type 2 diabetes meuitus,and 10.3%(12/116) were with impaired glucose tolerance.The average score of HAMA was(23 ± 7),23(19.8%) patients were with mild anxiety,30(25.9%) were with moderate anxiety,and 7(6.0%) were with severe anxiety.The average score of HAMD was(21 ± 6),22.4%(26 patients) were with mild depression,and 5.2%(6 patients) were with moderate depression.The total score of FCA was(71.1 ± 25.4),of which the scores of physical function and cognitive function were(50.9 ± 21.7) and(20.1 ± 6.8),respectively.Conclusion The main health problems among patients with stroke are chronic disease and psychological problems such as depression and anxiety.Tertiary rehabilitation in community should strengthen functional rehabilitation and psychological interventions and reduce the recurrence rate of stroke by monitoring and controlling blood pressure,blood glucose,and blood lipids of patients with stroke.