脑卒中慢性期患者生活质量状况及相关影响因素分析

The quality of life of long-term stroke patients and related factors

目的了解慢性期脑卒中患者的生活质量（QOL）状况，探讨其相关影响因素。方法对北京望京社区82例病程1年以上未复发脑卒中患者采用SF-36量表进行QOL调查，同时评测运动功能、抑郁、日常生活活动（ADL）自理能力，搜集患者的年龄、性别、文化程度、家庭收入等人口学特征及脑卒中并发症、合并症等疾病相关内容，采用多元逐步回归方法进行相关因素分析。结果单因素分析显示，人均月收入、医疗费、规律锻炼、运动功能、ADL能力水平、抑郁状态、合并高血压、并发症（肩痛）各因素与患者生活质量总积分有相关性（P〈0．05），与多数维度积分相关（P〈0．05）。以QOL总积分为因变量，多元逐步回归分析显示，运动功能、人均月收入、医药费引入回归方程，F=12．024，P〈0．001；R=0．583，R2=0．340，进入方程的三因素共同对QOL可以解释34．0％，运动功能对QOL影响程度最大，其次是人均月收入和医疗费，其余因素未进入回归方程。结论运动功能水平、人均月收入、医药费负担是影响脑卒中慢性期患者生活质量的主要因素，注重后期康复、规律锻炼、提高运动功能、改善患者的经济条件是提高脑卒中慢性期患者生活质量的关键。

Objective To investigate the quality of life （QOL） of patients with stroke and its related factors. Methods The QOL of eighty-two stroke survivors was assessed in terms of SF-36 scores, motor impairment （Fugl-Meyer）, disability [ Barthel index （BI）] and depression （HAMD） more than one year after their first episode. Their social demographic characteristics such as age, gender, education and income were recorded, as were the characteristics of their disease and any complications. Multiple regression analysis was used to analyse the related factors. Results The average age of the 82 subjects was 61.89±9.81 years （range, 33-81 ）. 56 of them were male （68.2%）. Scores on all items of the SF-36 for these subjects were lower than those of a normal population. Correlation analysis showed income, cost for medical care, regular exercise, movement function, ability in the activities of daily living, depression, hypertension and shoulder pain were significantly correlated with most of the SF-36 domain scores. Motor function, income and cost for medical care explained 34% of the variance in SF-36 scores. Motor function was the single most important factor. Conclusion The major factors affecting the QOL of stroke patients are motor function, level of income and cost for medical care. Paying more attention to rehabilitation treatment, taking regular exercise and more income could help improve the QOL of stroke survivors,