综合干预对首发脑卒中患者生存质量影响.docVIP

综合干预对首发脑卒中患者生存质量的影响 　　[摘要] 目的 了解通过综合性干预后，首发脑卒中患者的生存质量的变化情况。 方法 选取2013年4月～2015年4月上海市宝山区中西医结合医院（以下简称“我院”）神经内科及急诊科因首发脑卒中住院患者200例，利用SPSS 17.0进行随机化实验设计分组分为干预组及对照组，采用滚动入组方式。入组前进行简易精神状态检查量表（MMSE）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、日常生活能力量表（ADL）、健康状况问卷（SF-36）评估及痴呆发生率调查。后对干预组进行卒中后心理卫生宣教，出院2周后即并由固定医师定期上门指导卒中后肢体锻炼、心理行为干预，督促日常生活能力的训练，并安排我院康复科1～2次/周脑功能、生物反馈治疗，告知热线电话，便于随时解答，而对照组则不作任何措施。入组后3、6、12个月再次进行两组评估，以观察两组各量表总分变化及痴呆发病例数。 结果 至研究末，共164例患者完成最后评估，其中干预组81例，对照组83例，12个月后干预组痴呆发生率与对照组比较，差异有统计学意义（P 7分例数明显多于干预组，而抑郁量表评分变化比较，两组差异无统计学意义（P 0.05）。交互分析提示，随着病程增加，焦虑、抑郁情绪有恶化趋势。12个月时干预组的社会功能（ADL）明显好于对照组；SF-36中社会功能因子分同样提示干预组优于对照组（P 0.05）。 结论 综合性干预在一定程度上延缓了痴呆的发生，对患者卒中后社会功能保留及维持具有积极的作用，从而提高了卒中后患者的生存质量 [关键词] 综合康复训练；脑卒中；生存质量 [中图分类号] R742 [文献标识码] A [文章编号] 1674-4721（2016）09（a）-0059-05 [Abstract] Objective To understand the changes of the quality of life for patients with first stroke through the comprehensive intervention. Methods 200 patients with first stroke from Internal Medicine Department and Emergency Department in our hospital from April 2013 to April 2015 were chosen and divided into intervention group and control group in the process of randomized experimental design by SPSS 17.0， method of rolling into groups was used. Before entering the group， evaluations of MMSE， HAMA， HAMD， ADL， SF-36 and investigation on occurence rate of dementia were conducted. Then mental and health education for post-stroke was carried out in the intervention group. Also， the regular home visit of physical exercise for post-stroke was offered by fixed physician in two weeks after leaving hospital， as well as the training of psychological intervention and supervision ability of daily living. Moreover， brain function and biofeedback therapy were conducted for 1-2 times a week with the help of rehabilitation department. Patients were informed the hotline in order to answer their questions at any time， while the control group did no treatment. Evaluations were severally conducted between two groups after three mont