居家护理对中重型颅脑损伤患者长期预后的影响

The effect of home care service on the long-term outcome after moderate to severe traumatic brain injury

目的探讨居家护理在中重型颅脑损伤患者康复中的干预作用,改善颅脑损伤患者的长期生活质量。方法选择神经外科病房102例符合条件的颅脑损伤患者作为研究对象,试验组52例,对照组50例,试验组实施出院后居家护理,包括定期电话和上门随访,提供压疮护理、管道护理、气管切开护理、康复锻炼和自我护理的方法等。对照组进行常规出院宣教和门诊复查,两组患者于出院6个月、12个月时进行Karnofsky预后评定表、日常生活能力(ADL)和生活满意度评定,并观察患者并发症的发生情况。结果观察12个月时试验组与对照组Karnofsky预后和ADL评定指标比较,差异有统计学意义(P<0.05),生活满意度指标差别不大(P>0.05);试验组和对照组并发症发生率差异有统计学意义(P<0.05)。结论实施居家护理对改善颅脑损伤患者的机能状态、日常生活能力、降低患者并发症的发生率等方面有积极的作用,同时可以减轻家属的经济负担,节约医疗服务资源,为今后医院管理服务提供方向。

Objective To evaluate the effect of home care service on the long-term outcome and quality of life in patients with moderate to severe traumatic brain injury. Methods A total of 102 traumatic brain injury patients were recruited and divided into two groups. The routine discharge education and further consultation were provided for the 50 patients in the control group, In addition,the home care service including bedsore care,catheter care,tracheotomy care,rehabilitative exercises,and self-care were provided for the 52 patients in the experimental group through scheduled telephone and home visit intervention. The outcomes were evaluated with Karuofsky Activity Scale （KPS）,Barthel Index （BI）,and Satisfaction With Life Scale （SWLS） at 6 and 12 months after the intervention. Results At the 12 months after the intervention,there was no significant difference in the score of SWLS （P〉0.05）,while significant differences in the scores of KPS,BI and rate of complications between the two groups （P〈0.05）. Conclusion Home care service can promote the rehabilitation of physical function and abilities of daily living as well as reduce complications in the patients after traumatic brain injury,and thereby to relieve family burden and save medical resources.