脑卒中患者实施医养结合长期照护模式的实践与效果

Practice and effects of the model for integrated medicine combined with long-term care in post-stroke patients

目的探索对脑卒中后患者实施医养结合长期照护模式的可行性及其效果。方法 2013年6月-2014年12月期间,选择在湘南学院附属医院住院的脑卒中后患者195例,将出院后收住医院养老区的62例作为研究组,医院对其实施医养结合长期照护。将出院后居家养护的68例作为对照1组,出院后入住老年公寓的65例作为对照2组,于出院时、出院后3个月、6个月评价各组患者的Barthel指数、孤独感及出院后6个月患者的生存质量(GQOLI-74评分)。结果出院后3个月、6个月后,研究组Barthel指数评分(31.96±8.18、37.85±7.18)均明显高于对照1组(24.23±6.26、28.41±8.47)和对照2组(26.19±7.42、30.56±7.59),研究组UCLA孤独感评分(32.08±9.42、33.93±9.12)均明显低于对照1组(39.52±11.68、48.52±13.54)和对照2组(33.41±10.31、38.52±10.19),差异均有统计学意义(均P<0.01);出院6个月后,研究组患者GQOLI-74评分除物质生活维度外,其余三个维度(躯体功能、心理功能、社会功能)得分和总分均优于对照1组和对照2组(均P<0.01)。结论实施医养结合长期照护模式可明显提高脑卒中后患者的日常生活能力、生存质量、降低患者的孤独感。

Objective To study the feasibility and effects of the model for integrated medicine combined with long-term care in post-stroke patients.Methods We selected 195 post-stroke patients hospitalized in the Affiliated Hospital of Xiangnan University from June 2013 to December 2014.After discharge from hospital,62 patients receiving integrated medicine combined with long-term care in the elderly care department of the hospital served as the research group,68 patients receiving home-based care served as the control group I,and 65 patients living in the apartment for the aged served as the control group II.The Barthel indexes and loneliness on discharge and at 3,6 months after discharge,as well as the quality of life（GQOLI-74 scores）at 6 months after discharge were evaluated.Results Three and six months after discharge,the scores of Barthel index were significantly higher in the research group（31.96 ± 8.18,37.85 ± 7.18） than those in the control group I（24.23 ± 6.26,28.41± 8.47） and the control group II（26.19 ± 7.42,30.56 ± 7.59）,while the scores of UCLA loneliness were significantly lower in the research group（32.08 ± 9.42,33.93 ± 9.12） than those in the control group I（39.52 ± 11.68,48.52 ± 13.54） and the control group II（33.41 ± 10.31,38.52 ± 10.19）,all with statistically significant differences（P〈0.01）.Six months after discharge,except for the score of material life dimension,the scores of the other three dimensions of GQOLI-74 concerning physical,psychological and social functions as well as the total score in patients of the research group were all superior to those in the control group I and the control group II（all P〈0.01）.Conclusions Implementing the model for integrated medicine combined with long-term care can significantly improve the daily life ability and the quality of life and reduce the loneliness of post-stroke patients.