规范化三级康复护理模式对脑卒中后单侧空间忽略预后的影响

Effect of tertiary rehabilitation care on patients with post-stroke unilateral spatial neglect

目的 观察规范化的三级康复护理模式对脑卒中后单侧空间忽略（USN）患者预后的影响。方法 选择2013年1月—2015年11月浙江大学绍兴医院康复中心因脑卒中后USN住院病例,按USN诊断标准选择病例,最后符合USN入选标准的患者122例,通过随机编号将USN患者分为对照组和干预组。对照组给予一级康复治疗及二级康复治疗,干预组采用规范化的三级康复护理模式。分别于干预前、干预3个月、6个月后对2组患者进行USN严重程度和日常生活能力（ADL）评定。结果 干预3个月、6个月后2组患者Barthel指数均较治疗前显著增加（F=525.11,P〈0.01;F=989.26,P〈0.01）;中重度USN比例和Catherine-Bergego Scale（CBS）评分也得到显著改善（P均〈0.01）;干预组在3个月、6个月后Barthel指数的改善较对照组更为显著（t=2.597,P〈0.01;t=11.322,P〈0.01）,CBS评分降低更为明显（t=2.370,P〈0.05;t=3.949,P〈0.01）;中、重度USN患者比例与对照组比较在6个月后显著下降（χ2=4.32,P〈0.05）。结论 规范化的三级康复护理模式可以有效改善USN症状,提高患者的日常生活能力,有效地改善脑卒中患者单侧空间忽略严重程度。

Objective To observe the effect of standardized rehabilitation nursing in tertiary rehabilitation system on pa- tients with post-stroke unilateral spatial neglect（USN）. Methods According to diagnostic criteria for USN,we chose 122 patients who were in our rehabilitation center between January ,2013 and November,2015 and assigned them into a control group and intervention group based on serial number. The control group was given level-1 and level-2 rehabilitation nurs- ing ,while the intervention group was given the standardized tertiary rehabilitation system. A comparative assessment on the severity of USN and the Activities of Daily Living（ADL） of the patients were evaluated before and after the treatment（ for three months and six months）. Results The Barthel index of these two groups of patients had increased significantly after three months and six months of treatment （F = 525.11, P 〈 0.01;F = 989.26,P 〈 0.01 ） ;furthermore, the severity of USN （ P 〈 0.01 ） and Catherine-Bergego Scale （CBS） score （ P 〈 0.01 ） had also been significantly improved ; and the Barthel index of the intervention group was more obviously improved than that of the control group after three months and six months of treatment（ t = 2. 597, P 〈 0.01 ; t = 11. 322, P 〈 0.01 ）, so was the decline of CBS （ t = 2.37, P 〈 0.05 ; t = 3. 949 ,P 〈0.01 ） ;and the proportion of patients with severe USN in the intervention group was obviously declined than that of the control group after six months of treatment X2 = 4.32, P 〈 0.05 ）. Conclusion The standardized tertiary reha- bilitation care can effectively improve the symptoms of USN and the patients＇ activities of daily living, effectively improve the severity of USN.