远程指导型家庭病床对脑卒中偏瘫患者康复的作用

The rehabilitative effects on stroke patients of hospital at home under remote guidance

目的:探讨综合性医院康复科主导的远程指导型家庭病床对脑卒中患者的康复疗效。方法:将60例卒中偏瘫患者随机分为家庭病床组和对照组,家庭病床组由本院康复科通过定期的远程视频指导患者及其陪护人员进行相关的医疗护理、康复训练及心理辅导,对照组仅接受常规社区康复治疗。分别于治疗前及治疗6个月后采用改良Barther指数评定(MBI)、Fugl-Meyer运动功能评分(FMA)、Berg平衡量表评分(BBS)评定肢体功能恢复状况;采用汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分评价患者心理状况;于治疗14 d时运用调查问卷对2组患者的康复护理满意度进行评估。结果:治疗6个月后家庭病床组MBI、FMA、BBS评分均高于对照组,差异有统计学意义(P<O.05);同时HAMA评分、HAMD评分结果显示家庭病床组焦虑、抑郁程度较轻,差异有统计学意义(P<O.05);治疗14 d时满意度调查显示对照组相比远程指导型家庭病床组患者在疾病相关信息获取、夜间护理状况方面表现较差,且夜间安全感缺乏较明显,2组差异有统计学意义(P<O.05)。结论:综合性医院康复科远程视频指导下个体化家庭病床对脑卒中患者肢体功能与心理状态的恢复都优于单纯社区康复,新型网络指导技术作为医疗辅助手段值得推广。

Objective： To evaluate the physical and psychological rehabilitative effects on stroke patients in hospital at home service under remote guidance. Methods： Sixty patients were randomly divided into remote guidance group（RG） or normal hospital at home group（NH）. The RG patients recieved a termly remote guidance from the physicians after discharge, including medical care, rehabilitation training and psychological counseling. The physical and psychological rehabilitative effects were evaluated by MBI（modified barther index）, FMI（fugl-meyer assessment scale）, BBA（berg balance scale）, HAMA（hamilton anxiety scale） and HAMD（hamilton depression scale） scales after 6 months therapy, and by satisfaction survey after 14 days. Results： The RG group manifested better results of the MBI, FMI, BBA, HAMA and HAMD scales results（P〈0.05）. Patients in NH group reflected dissatisfaction of night care and information acquisition, they feel more insecurity at night（P〈0.05）. Conculsion： Hospital at home service under remote guidance has better effect in physical and mental rehabilitation on the stroke patients. New network technology as a medical aid guide is worth popularizing.