老年脑卒中病人出院准备度及其相关影响因素

Clinical analysis of discharge preparation for hospitalized patients with stroke and its related influencing factors

目的探讨老年脑卒中病人出院准备度与出院指导质量的临床情况,分析影响病人出院准备度的相关因素。方法采用方便抽样的方法,选取2016年4月至2017年10月南京市3所三级甲等医院神经内科出院的老年脑卒中病人348例,分析病人出院准备度与出院指导质量的临床情况及其相关影响因素。结果病人出院准备度总得分为(98.45±11.13)分,有82.76%的病人满意出院准备度;病人出院指导质量总得分为(143.45±20.13)分,有86.21%的病人满意出院指导质量;老年脑卒中病人出院准备度与出院指导质量呈正相关(r=0.624,P<0.001)。多因素回归分析显示,出院指导质量(OR=2.467,P<0.05)、感知自理能力下降(OR=0.514,P<0.05)、长期规律服药(OR=0.501,P<0.05)、家庭人均月收入(OR=1.501,P<0.05)、Barthel指数评分(OR=0.968,P<0.05)、艾森卒中风险量表(ESRS)评分(OR=0.566,P<0.05)以及合并症种类(OR=0.310,P<0.05)是影响老年脑卒中病人出院准备度的重要因素。结论老年脑卒中病人出院指导质量、感知自理能力下降、长期规律服药、家庭人月均收入、Barthel指数评分、ESRS评分以及合并症种类是影响老年脑卒中病人出院准备度的重要因素。医院需加强服务意识,切实落实出院准备,使病人拥有充分的出院准备条件,增强其自我管理及康复能力,降低脑卒中复发率。

Objective To investigate the clinical status of discharge preparation and discharge guidance quality in the elderly patients with stroke,and to analyze the related factors that affect the patients'readiness for discharge.Methods By adopting a convenient sampling method,348 elderly stroke patients who were discharged from the department of Neurology of three tertiary-level hospitals in Nanjing from April 2016 to October 2017 were selected to analyze the clinical status of patients'readiness for discharge and discharge guidance quality and the related influencing factors of discharge preparation.Results The total score of patients'preparation readiness was(98.45±11.13)points,and 82.76% of the patients were satisfied with discharge preparation.The total score of quality of discharge guidance was(143.45±20.13)points,and 86.21% of the patients were satisfied with the discharged guidance quality.There was a positive correlation between readiness for discharge and guidance quality in elderly patients with stroke(r=0.624,P<0.001).The multivariate Logistic analysis showed that the quality of discharge guidance,decreased ability to sense self-care,long-term regular medication,monthly mean family income,Barthel index score,Essen stroke risk score(ESRS),and comorbidities were important factors influencing stroke patients'preparation readiness(P<0.05).Conclusions The quality of discharged guidance decreased ability to sense self-care,long-term regular medication,monthly mean family income,Barthel index score,ESRS score,and comorbidity type are important factors for hospital readiness in elderly patients with stroke.The service consciousness of hospital should be strengthened to improve the hospital discharge preparations,and to reduce the relapse rate of stroke.