制定出院计划对脑卒中偏瘫患者出院后疗效观察

Efficacy observation of making discharge plan on stroke patients with hemiplegia after discharge

目的探讨制定出院计划对脑卒中偏瘫患者出院后的疗效。方法选择2019年4月—2020年3月宜春市人民医院康复科出院的60例脑卒中偏瘫患者作为研究对象,按照随机数字表法分为对照组和观察组,每组30例。两组患者均给予预防脑卒中复发的常规口服药物治疗,对照组指导出院后给予一般的康复训练,观察组由康复医师、康复治疗师、护士联合制定详细出院计划,包括改变居住环境、简单康复器材、具体康复训练方法等。每2周随访,根据功能水平制定不同康复计划。观察两组患者出院时、出院后3个月自我效能感、神经功能缺损程度评分、日常生活能力(ADL)指数、肢体运动功能(FMA)评分及生存质量评估;评价上、下肢肌张力疗效,依从性。结果出院时,两组自我效能、神经功能缺损程度评分比较,差异无统计学意义(P>0.05);出院后3个月,两组自我效能感高于本组出院时,且观察组高于对照组,差异有统计学意义(P<0.05);出院后3个月,两组神经功能缺损程度评分低于本组出院时,且观察组低于对照组,差异有统计学意义(P<0.05)。出院时两组ADL、FMA、生存质量评分比较,差异无统计学意义(P>0.05);出院后3个月,两组ADL、FMA、生存质量评分高于本组出院时,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组上、下肢肌张力疗效高于对照组,差异有统计学意义(P<0.05)。观察组依从性(按时服药、控制烟酒、康复训练、合理饮食、自我监测、按时复诊)高于对照组,差异有统计学意义(P<0.05)。结论制定出院计划对脑卒中偏瘫患者出院后的疗效较好,可以改善患者的自我效能感、神经功能缺损程度评分、日常生活能力指数、日常生活能力指数、FMA评分及生存质量,提高患者的上肢肌张力疗效、下肢肌力疗效和患者的依从性,应用价值较高。

Objective To explore the efficacy of making discharge plan on stroke patients with hemiplegia after discharge.Methods A total of 60 patients with stroke hemiplegia discharged from the Department of Rehabilitation,Yichun People's Hospital from April 2019 to March 2020 were selected as the research subjects.They were divided into the control group and the observation group according to the random number table method,with 30 cases in each group.Patients of both groups were given routine oral medication to prevent stroke recurrence,the control group guided the general rehabilitation training after discharge,and the observation group jointly developed a detailed discharge plan by rehabilitation physicians,rehabilitation therapists and nurses,including changing the living environment,simple rehabilitation equipment,specific rehabilitation training methods,etc.The patients were followed up every 2 weeks,and different rehabilitation plans were made according to the functional level.The self-efficacy,neurological deficit score,activity of daily living index,activities of daily living(ADL)index,Fugl-Meyer assessment(FMA)score and quality of life of the two groups were observed at the time of discharge and 3 months after discharge,and the efficacy of upper limb muscle tension,lower limb muscle strength and compliance were evaluated.Results There were no statistically significant difference in the scores of self-efficacy and neurological deficit degree between the two groups at discharge(P>0.05).Three months after the discharge,the self-efficacy of two groups was higher than that at discharge,while the self-efficacy of the observation group was higher than that of the control group,and the differences were statistically significant(P<0.05).Three months after the discharge,the neurological deficit degree of two groups was lower than that at discharge,while the neurological deficit degree of the observation group was lower than that of the control group,and the differences were statistically significant(P<0.05).There were no significant differences in ADL,FMA and quality of life scores between the two groups at discharge(P>0.05).Three months after the discharge,the ADL,FMA and quality of life scores of two groups were lower than those at discharge,while the ADL,FMA and quality of life scores of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).The efficacy of the upper and lower limb muscle tension of the observation group was higher than that of the control group,and the differences were statistically significant(P<0.05).The compliance(taking medication on time,controlling tobacco and alcohol control,rehabilitation training,reasonable diet,self-monitoring,re-visit and visit on time)of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion The development of discharge plan has a good effect on stroke hemiplegic patients after discharge.It can improve the patients'self-efficacy,neurological deficit score,activity of daily living index,activity of daily living index,FMA score and quality of life,and improve the upper limb muscle tension efficacy,lower limb muscle strength efficacy and patients'compliance.