脑卒中偏瘫患者早期康复临床路径的构建与应用研究

Development and implementation of an early rehabilitation clinical pathway for stroke patients with hemiplegia

目的基于康复指南构建早期康复临床路径,并探讨其应用于缺血性脑卒中患者中的效果。方法选取2019年1~10月符合标准的缺血性脑卒中患者共112例,将1~5月入院者设为对照组,6~10月入院者设为干预组,每组各56例。两组分别在住院期间给予干预,对照组采用常规早期康复模式;干预组实施早期康复临床路径模式,即实施基于文献研究结合早期康复相关证据形成的偏瘫患者早期康复临床路径与流程。采用美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer评定量表(FMA)、Barthel指数(BI)、患者出院满意度评分量表评价效果。结果干预后,干预组NIHSS评分显著低于对照组(P<0.01);FMA评分显著高于对照组(P<0.01);干预组出院时、出院1、3、6个月的BI评分显著高于对照组(均P<0.01);干预组患者出院满意度评分显著高于对照组(P<0.01)。结论基于康复指南构建早期康复临床路径,并应用于缺血性脑卒中患者,可有效改善其肢体功能障碍,提高患者日常生活活动能力,提高患者满意度。

Objective To develop a clinical pathway for early rehabilitation based on guidelines and to explore the effect of application in patients with ischemic stroke.Methods One hundred and twelve patients with ischemic stroke admitted from January to October 2019 were assigned into two groups.Patients admitted from January to May were served as the control group(n=56)and given routine early rehabilitation,while those admitted from June to October were treated as the intervention group(n=56)and received early rehabilitation following a clinical pathway,which was developed based on literature review and the best evidence regarding early rehabilitation.The NIH Stroke Scale(NIHSS),Fugl-Meyer Assessment(FMA),Barthel Index(BI)and patient satisfaction were used to evaluate the effect.Results The NIHSS score was significantly lower,whereas FMA score was significantly higher in the intervention group than those in the control group(P<0.01 for all).BI scores at discharge,1,3 and 6 months after discharge,as well as patient satisfaction at discharge in the intervention group were significantly higher compared with the control group(P<0.01 for all).Conclusion Implementation of guideline-based early rehabilitation clinical pathway in patients with ischemic stroke can effectively improve their limb function,performance in activities of daily living,and satisfaction with nursing care.