卒中单元与社区医疗服务结合模式对脑卒中患者临床疗效的影响

Supplementing the effects of a stroke unit with community health services for stroke patients

目的探讨卒中单元与社区医疗服务结合模式对脑卒中患者临床疗效的影响。方法将120例脑卒中患者随机分成3组，分别是卒中单元＋社区医疗组（简称联合组）、卒中单元组及普通治疗组。前2组患者在住院期间接受卒中单元模式治疗，普通治疗组仅给予常规内科治疗。出院后联合组患者通过社区医疗服务形式继续接受定期康复指导，卒中单元组仅进行随诊观察。分别于入选、出院时及出院3个月后采用Fugl-Meyer评分法评定肢体运动功能，采用Barthel指数（BI）评定日常生活活动（ADL）能力，采用抑郁自评量表（SDS）评定抑郁情绪，并对各组患者评定结果进行比较。结果3组患者入选时，其肢体运动功能、ADL能力及抑郁情绪组间差异均无统计学意义（P〉0．05）；出院时联合组、卒中单元组肢体运动功能及ADL能力均明显优于普通治疗组（P〈0．05）；出院3个月后，发现联合组、卒中单元组肢体运动功能及ADL能力均较出院时进一步改善，且以联合组的改善幅度较显著，与卒中单元组比较，组间差异具有统计学意义（P〈0．05）。3组患者出院时抑郁情绪无明显差异（P〉0．05）；出院3个月后联合组、卒中单元组抑郁情绪明显好转，且以联合组的改善幅度较显著，与卒中单元组比较，组间差异具有统计学意义（P〈0．05）。结论卒中单元与社区医疗服务结合模式对脑卒中患者肢体运动功能、ADL能力及抑郁情绪具有显著改善作用，值得大力推广、应用。

Objective To evaluate the clinical efficacy of a stroke unit combined with community health services for treating stroke survivors. Methods A total of 120 stroke patients were randomly divided into a ＂ stroke unit combined with community medicine＂ group （ combined group） , a stroke unit group and a general treatment group. Patients in the former 2 groups were treated in a hospital stroke unit during their hospitalization. The general treatment group was given conventional medical treatment. After discharge, the combined group continued to receive regular rehabilitation therapy and guidance in the form of community medical services, while the stroke unit group received follow-up only. Assessment was by means of Fugl-Meyer scores, the Barthel index and self-rating on a depression scale （SDS）. The patients were assessed at admission, on discharge and 3 months after discharge. Results There were no significant differences in average limb motor function, ability in the activities of daily living （ADL） or depressive mood among the 3 groups on admission, but at discharge, limb motor function and ADL ability in the combined group and stroke unit groups were significantly superior to those in the general therapy group. Limb motor function and ADL ability in the combined and stroke unit groups had improved further 3 months after discharge, with more significant improvements in the combined group. No significant change in depression was observed in any group at discharge, but average depression scores in the combined and stroke unit groups improved significantly in the 3 months after discharge, and there was a statistically significant difference between the combined group and the general group. Conclusion Supplementing the work of a stroke unit with community health services significantly improves stroke patients＇ recovery of limb motor function and ADL ability.