老年急性缺血性脑卒中偏瘫患者出院后生活质量现状及其影响因素

Status quo and influencing factors of quality of life in elderly patients with acute ischemic stroke hemiplegia after discharge

目的分析老年急性缺血性脑卒中(AIS)偏瘫患者出院后生活质量现状及其影响因素。方法收集2022年1月至12月江苏省人民医院神经内科收治的408例老年AIS偏瘫患者的临床资料。使用卒中专门生存质量量表(SSQOL)评估患者出院后1个月的生活质量。根据SSQOL评分结果,将患者分为生活质量良好组(SSQOL评分≥123分,n=225)及生活质量不良组(SSQOL评分<123分,n=183)。使用SPSS 23.0统计软件进行数据分析。根据数据类型,组间比较分别采用独立样本t检验或χ^(2)检验。采用多因素logistic回归分析影响老年AIS偏瘫患者出院后生活质量的危险因素。结果408例老年AIS偏瘫患者出院后1个月SSQOL评分为(136.35±5.38)分,标准化得分为(56.30±5.21)%,生活质量处于中等水平。生活质量不良组与生活质量良好组医疗费用支付方式、婚姻状况、主要照护者、患侧Ashworth痉挛分级、日常生活能力及抑郁症状方面比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,医疗费用自费(OR=2.573,95%CI 1.550~4.271)、患侧Ashworth痉挛分级为Ⅱ级(OR=2.085,95%CI 1.030~4.223)、日常生活重度依赖(OR=3.435,95%CI 2.285~5.163)、抑郁症状(OR=3.114,95%CI 1.919~5.054)是老年AIS偏瘫患者出院后生活质量不良的危险因素(均P<0.05);已婚(OR=0.573,95%CI 0.031~0.892)、主要照护者为配偶(OR=0.642,95%CI 0.109~0.980)则为保护因素(均P<0.05)。结论医疗经济负担、患侧肌张力较高、日常生活能力受限以及抑郁是老年AIS偏瘫患者出院后生活质量的重要影响因素,而配偶陪伴及照护对改善患者生活质量有利。

Objective To analyze the status quo and influencing factors of quality of life in elderly patients with hemiplegia after discharge due to acute ischemic stroke(AIS).Methods Clinical data of 408 elderly AIS hemiplegic patients admitted to our department from January to December 2022 were collected.Stroke Specific Quality of Life Scale(SSQOL)was used to assess the quality of life of these patients one month after discharge.According to the SSQOL score,they were divided into a good life-quality group(SSQOL score≥123,n=225)and a poor life-quality group(SSQOL score<123,n=183).SPSS 23.0 statistical software was employed for data analysis.Independent sample t test or Chi-square test was utilized for intergroup comparison depending on different data type.Multivariate logistic regression analysis was applied to identify risk factors affecting the quality of life of elderly AIS hemiplegic patients after discharge.Results The SSQOL score of 408 elderly patients with AIS hemiplegia at one month after discharge was(136.35±5.38),and the standardized score was(56.30±5.21)%,which was at a moderate level.There were statistically significant differences between poor life-quality group and good life-quality group in terms of payment method of medical expense,marital status,main caregivers,Ashworth spasm grade of affected side,activity of daily living and depression symptom(P<0.05).Multivariate logistic regression analysis showed that self-paying of medical expense(OR=2.573,95%CI 1.550-4.271),affected side at Ashworth spasm gradeⅡ(OR=2.085,95%CI 1.030-4.223),heavy dependence on daily life(OR=3.435,95%CI 2.285-5.163),and depression symptom(OR=3.114,95%CI 1.919-5.054)were risk factors for poor quality of life in elderly patients with AIS hemiplegia after discharge,and married status(OR=0.573,95%CI 0.031-0.892)and spouse as the main caregiver(OR=0.642,95%CI 0.109-0.980)were protective factors(all P<0.05).Conclusion Medical economic burden,high muscle tension of affected side,limited ability of daily life and depression are important influencing factors of quality of life in elderly patients with AIS hemiplegia after discharge,and spouse companionship and care are beneficial to improving their quality of life.