中期照护对老年脑梗死患者复发因素及复发率的影响

Effect of intermediate care on the recurrence and recurrence rate of elderly patients with cerebral infarction

目的观察中期照护对老年脑梗死患者复发因素及复发率的影响。方法将符合标准的598例急性期后脑梗死患者分为两组：试验组301例，对照组297例。试验组在急性期病情稳定后收入中期照护病房，给予综合评估和多学科管理，根据评估结果给予中西医结合治疗、康复训练和物理治疗、用药指导、护理及健康教育。对照组在急性期病情稳定后入住普通病房。疗程均为2周。并于照护前（t0）、2周（t1）、6个月（t2）、12个月（t3）观察两组患者的血压（SBP、DBP）、FBG、血脂（TC、TG、LDL-C）、血清同型半胱氨酸（Hcy）水平，及两组患者的脑梗死复发率。结果SBP组内比较，试验组t1、t2、t3低于t0，差异均有统计学意义（P均〈0.05）；SBP组间比较，试验组t2、t3低于对照组，差异均有统计学意义（P均〈0.05）。DBP组内比较，试验组t2、t3低于t0，差异均有统计学意义（P均〈0.05）；DBP组间比较，试验组t2、t3低于对照组，差异均有统计学意义（P均〈0.05）。试验组FBG在t1[（5.34±0.76） mmol/L]、t2[（5.86±1.05） mmol/L]、t3[（5.62±0.89） mmol/L]低于t0[（7.27±2.34） mmol/L]，差异均有统计学意义（P均〈0.05）；与对照组t2[（6.85±0.92） mmol/L]、t3[（6.36±1.03） mmol/L]比较差异有统计学意义（P均〈0.05）。试验组TC在t1[（4.86±0.85） mmol/L]、t2[（4.21±0.76） mmol/L]、t3[（3.95±0.64） mmol/L]低于t0[（5.56±1.06） mmol/L]，差异均有统计学意义（P均〈0.05）；与对照组t2[（5.06±0.93） mmol/L]、t3[（4.84±0.76） mmol/L]比较差异均有统计学意义（P均〈0.05）。试验组TG在t3[（1.48±0.26） mmol/L]低于t0[（1.86±1.31） mmol/L]，差异有统计学意义（P〈0.05）；与对照组t3[（1.71±0.66） mmol/L]比较差异有统计学意义（P〈0.05）。试验组LDL-C在t1[（3.76±0.92） mmol/L]、t2[（3.09±0.62） mmol/L]、t3[（2.59±0.51） mmol/L]低于t0[（4.59±1.45） mmol/L]，差异均有统计学意义（P均〈0.05）；与对照组t2[（4.09±0.75） mmol/L]、t3[（4.12±0.64） mmol/L]比较差异均有统计学意义（P均〈0.05）。试验组Hcy在t1[（14.16±3.17） μmol/L]、t2[（10.37±2.59） μmol/L]、t3[（10.10±1.86） μmol/L]低于t0[（23.62±5.62） μmol/L]，差异均有统计学意义（P均〈0.05）；与对照组t2[（18.52±3.64） μmol/L]、t3[（16.37±2.75） μmol/L]比较差异均有统计学意义（P均〈0.05）。试验组和对照组1年内脑梗死复发率分别为4.7%（14/301）和7.1%（21/297），有减低趋势，但差异无统计学意义（P＝0.208）。结论中期照护可影响老年脑梗死患者的血压、FBG、血脂、血清Hcy水平，可一定程度上降低脑梗死的复发率。

ObjectiveTo observe the effect of intermediate care on recurrence factors and recurrence rate of elderly patients with cerebral infarction.MethodsFive Hundred and ninety-eight cases of acute cerebral stroke were divided into two groups, 301 cases in the experimental group and 297 cases in the control group.After the acute stage, patients in the experimental group was included into the intermediate care unit.The experimental group was given comprehensive evaluation and multidisciplinary management, including the combination of traditional Chinese and Western medicine treatment, rehabilitation training and physical therapy, medication guidance, nursing and health education.After the acute stage of the disease, the control group patients were in the general ward.The course of treatment was 2 weeks.At baseline（t0）, second weeks（t1）, sixth months（t2） and twelfth months（t3）, the blood pressure（SBP, DBP）, fasting blood-glucose （FBG）, blood lipid（TC, TG, LDL）, serum homocysteine（Hcy） level and the recurrence rate of cerebral infarction in all two groups were observed.ResultsSBP at t1, t2 and t3 was lower than that at t0 in the experimental group, and the difference was statistically significant（P〈0.05）. SBP in the experimental group at t2 and t3 was lower than that in the control group.There was significant difference between the experimental group and the control group（P〈0.05）. DBP at t2 and t3 was lower than that at t0 in the experimental group, and the difference was statistically significant（P〈0.05）. DP in the experimental group at t2 and t3 was lower than that in the control group.There was significant difference between the experimental group and the control group（P〈0.05）. FBG at t1（（5.34±0.76） mmol/L）, t2（5.86±1.05） mmol/L） and t3（5.62±0.89） mmol/L） were lower than that at t0（（7.27±2.34） mmol/L）, and the difference was statistically significant（P〈0.05）. FBG in the experimental group at t2 and t3 were lower than that in the control group（（6.85±0.92） mmol/L, （6.36±1.03） mmol/L）. There was significant difference between two groups（P〈0.05）. TC at t1（（4.86±0.85） mmol/L）, t2（（4.21±0.76） mmol/L） and t3（（3.95±0.64） mmol/L） were lower than that at t0（（5.56±1.06） mmol/L）, and the difference was statistically significant（P〈0.05）. TC in the experimental group at t2 and t3 was lower than that in the control group（（5.06±0.93） mmol/L, （4.84±0.76） mmol/L）. There was significant difference between two groups（P〈0.05）. TG at t3（（1.48±0.26） mmol/L） was lower than that at t0（（1.86±1.31） mmol/L）, and the difference was statistically significant（P〈0.05）. TG in the experimental group at t3 was lower than that in the control group（（1.71±0.66） mmol/L）. There was significant difference between two groups（P〈0.05）. LDL at t1（（3.76±0.92） mmol/L）, t2（（3.09±0.62） mmol/L） and t3（（2.59±0.51） mmol/L） were lower than that at t0（（4.59±1.45） mmol/L）, and the difference was statistically significant（P〈0.05）. LDL in the experimental group at t2and t3 was lower than that in the control group（（4.09±0.75） mmol/L, （4.12±0.64） mmol/L）. There was significant difference between two groups（P〈0.05）. Hcy at t1（（14.16±3.17） μmol/L）, t2（（10.37±2.59） μmol/L） and t3（（10.10±1.86） μmol/L） were lower than that at t0（（23.62±5.62） μmol/L）, and the difference was statistically significant（P〈0.05）. Hcy in the experimental group at t2and t3 was lower than that in the control group（（18.52±3.64） μmol/L, （16.37±2.75） μmol/L）. There was significant difference between two groups（P〈0.05）. The recurrence rate of cerebral infarction within 1 years was 4.7%（14/301） and 7.1%（21/297） in the experimental group and the control group.There was a decreasing tendency, but no statistical significance（P=0.208）.ConclusionThe intermediate care may affect the blood pressure, FBG, blood lipids, serum Hcy levels in elderly patients with cerebral infarction, so as to reduce the recurrence rate of cerebral infarction.