摘要
目的通过对住院脑卒中偏瘫患者出院后的去向与功能转归进行回顾性分析，以明确脑卒中三级康复的必要性。方法以在我院接受脑卒中康复治疗出院一段时间后再次入院康复治疗的脑卒中偏瘫患者为研究对象，如患者出院后未转入其他康复机构进行治疗、仅进行家庭康复干预则纳入家庭组（共有患者121例），如患者出院后继续转至其它康复机构进行康复治疗则纳入康复组（共有患者47例）。对2组患者一般资料情况、出院及再次入院时Barthel指数（BI）评分、Holden步行功能分级等疗效指标进行分析比较。结果康复组患者再次人院时其肩痛人次、活动受限关节数量、肌张力≥1＋级的关键肌群数量均明显少于家庭组；通过相关性分析发现，家庭组患者再次人院时与初次出院时BI差值与患者发病年龄、合并症数量具有负相关性，与出院时BI评分、Holden步行功能分级具有正相关性；将家庭组BI差值与出院时BI评分、Holden步行功能分级进行曲线回归分析，发现如出院时BI评分≥45分，则患者出院回家后其BI评分可维持稳定，当出院时Holden步行功能分级≥2级，则患者回归家庭后步行功能不至于退步。结论脑卒中偏瘫患者出院后继续接受机构内康复治疗，能进一步提高其BI评分及Holden步行功能分级，抑制并发症发生；如脑卒中患者出院时BI评分≥45分或Holden步行功能分级≥2级，则患者回归家庭后功能可基本维持，但患者仍需进行适当康复干预以促进功能恢复、预防并发症发生。
Objective To explore the necessity of graded rehabilitation interventions for stroke by means of a retrospective analysis of the destination and functional outcome of stroke patients. Methods One hundred and twentyone stroke patients discharged from the authors＇ department in a tertiary hospital after hospitalized rehabilita tion treatment and continued with no guided rehabilitation training at home for a period of more than 15 days before re admission to the department were recruited as the family group, another 47 patients discharged from the same depart ment and continued with hospitalized rehabilitation treatment in other institutions for a period of more than 15 days be fore readmission to the department were recruited as the rehabilitation group. The demographic data, the patients＇ Barthel index scores Holden gait classifications at discharge from the authors＇ department and at readmission of both groups were analyzed and compared. Results The complications in rehabilitation group were much less than in the family group. The difference of Barthel index scores between previous discharge and readmission in family group was negatively correlated with the age of stroke onset, number of complications, and was positively correlated with the Barthel index score and Holden classification at the previous discharge. It was also found that the patients in family group would remain stable with their ADL performance and gait if their BI score was equal or above 45 and Holden classification equal or above grade 2 at the previous discharge. Conclusion Stroke patients in tertiary hospitalized rehabilitation program should be discharged either to secondary institution or family in accordance to their functional status.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2013年第11期855-858,共4页
Chinese Journal of Physical Medicine and Rehabilitation
