缺血性脑卒中偏瘫住院患者急性期恢复效果及其影响因素分析
发布时间：2018-09-18 17:55
【摘要】：目的:阐明护理干预措施在缺血性脑卒中偏瘫患者急性期病情恢复过程中的作用及影响,筛选缺血性脑卒中偏瘫患者急性期恢复效果的影响因素,为临床缺血性脑卒中患者急性期个体化护理干预方案提供参考。方法:149例缺血性脑卒中偏瘫患者均选自山西省某三级甲等医院神经内科,基于目前临床常规的脑卒中治疗方案,将患者根据护理康复方案情况不同分为护理+针灸治疗组、护理+康复治疗组及护理+针灸康复联合治疗组(以下简称护理+联合康复组)三组。在护理干预前根据统一设计的Epi Data数据库收集所有患者的资料,包括人口学特征指标,生活行为习惯,既往疾病史与家族史,入院时的实验室检测指标,梗死类型及梗死部位,入院治疗前的MBI及NIHSS评分等资料,并于患者出院时再次收集MBI及NIHSS评分。对患者急性期恢复效果的分析采用重复测量资料方差分析法,影响急性期恢复效果的因素分析采用logistic回归分析法。结果:在临床上常规治疗与护理干预前,护理+针灸治疗组,护理+康复治疗组,护理+联合康复组三组患者的一般情况基本相近,人口学特征指标、生活行为习惯、既往疾病史与家族史、入院时实验室检测指标等情况分布基本均衡。护理+针灸治疗组,护理+康复治疗组,护理+联合康复组三组患者治疗前MBI及NIHSS评分有差别,认为三组患者在治疗前的基本病情程度不同,护理+针灸治疗组患者在治疗前的病情程度远比护理+康复治疗组及护理+联合康复组的患者轻,护理+康复治疗组及护理+联合康复组患者在治疗前的病情程度尚不能认为有差别。护理+针灸治疗组,护理+康复治疗组及护理+联合康复组三组患者治疗前后的MBI评分经比较,F=133.237,P0.001,说明不同治疗组患者治疗前后的MBI评分有差别,护理+针灸治疗组患者MBI得分提高幅度更大。护理+针灸治疗组,护理+康复治疗组及护理+联合康复组三组患者治疗前后的NIHSS评分经比较,F=70.497,P0.001,说明不同治疗组患者治疗前后的NIHSS评分有差别,三组患者NIHSS分值变化幅度的差别无统计学意义。年龄、护理+常规治疗分组及治疗前NIHSS评分是影响患者治疗后MBI评分的有意义因素。60岁及以上的患者急性期的恢复效果不如60岁以下的患者好,OR值为0.403;护理+康复治疗组患者的恢复效果较护理+针灸治疗组的患者好,OR值为9.616;护理+联合康复组患者的恢复效果较护理+针灸治疗组的患者好,OR值为2.235;治疗前NIHSS评分低患者的恢复效果较治疗前NIHSS评分高的患者好,OR值为0.126。护理+常规治疗分组及治疗前NIHSS评分是影响患者治疗后NIHSS评分的有意义因素。护理+康复治疗组患者急性期的恢复效果较护理+针灸治疗组的患者好,OR值为5.947;护理+联合康复组患者的恢复效果较护理+针灸治疗组的患者好,OR值为1.513;治疗前NIHSS评分低患者的恢复效果较治疗前NIHSS评分高的患者好,OR值为1.161。结论:MBI及NIHSS评分既是评价患者病情程度的指标,也是反映患者急性期护理干预效果的指标。基于临床治疗护理的现状,护理+针灸治疗组、护理+康复治疗组及护理+联合康复组三组患者治疗护理干预前后的MBI及NIHSS评分有差别,急性期护理干预提高了患者的恢复效果。年龄、护理+常规治疗分组及治疗前NIHSS评分是影响患者治疗后MBI评分的有意义因素。护理+常规治疗分组及治疗前NIHSS评分是影响患者治疗后NIHSS评分的有意义因素。
[Abstract]:Objective: To clarify the effect and influence of nursing intervention on the recovery of hemiplegic patients with ischemic stroke in acute phase, and to screen the influencing factors of the recovery effect of hemiplegic patients with ischemic stroke in acute phase, so as to provide reference for individualized nursing intervention in acute phase of ischemic stroke. Patients with hemiplegia were selected from the Department of Neurology of a Grade A hospital in Shanxi Province. Based on the current clinical routine treatment of stroke, the patients were divided into three groups according to the different nursing rehabilitation programs: nursing + acupuncture treatment group, nursing + rehabilitation treatment group and nursing + acupuncture rehabilitation combined treatment group (hereinafter referred to as nursing + rehabilitation group). Before the intervention, all patients'data were collected according to the uniformly designed Epi Data database, including demographic characteristics, living habits, past disease history and family history, laboratory tests at admission, type and location of infarction, MBI and NIHSS scores before admission, and MBI and NIH were collected again at discharge. Results: Before routine treatment and nursing intervention, nursing + acupuncture treatment group, nursing + rehabilitation treatment group and nursing + combined rehabilitation group were in general. The distribution of demographic characteristics, living habits, past disease history and family history, and laboratory tests at admission were basically balanced. There were differences in MBI and NIHSS scores between the three groups before treatment. The degree of the disease is different. the degree of the patients in the nursing + acupuncture group before treatment is much lighter than that in the nursing + rehabilitation group and the nursing + rehabilitation group. the degree of the patients in the nursing + rehabilitation group and the nursing + rehabilitation group before treatment can not be considered to be different. The MBI scores of the three groups before and after treatment were compared, F=133.237, P 0.001, indicating that the MBI scores of the patients in the different treatment groups before and after treatment were different, and the MBI scores of the patients in the nursing + acupuncture treatment group increased by a greater margin. SS score was compared, F = 70.497, P 0.001, indicating that different treatment groups before and after treatment NIHSS score difference, three groups of patients with NIHSS score changes in the range of no significant difference. The recovery effect of the nursing + rehabilitation group was better than that of the nursing + acupuncture group, the OR value was 0.403; the recovery effect of the nursing + rehabilitation group was better than that of the nursing + acupuncture group, the OR value was 9.616; the recovery effect of the nursing + rehabilitation group was better than that of the nursing + acupuncture group, the OR value was 2.235; the recovery effect of the patients with low NIHSS score before treatment was better than that of the treatment group. The patients with high NIHSS score before treatment had a better OR value of 0.126. Nursing + routine treatment group and NIHSS score before treatment were the significant factors affecting NIHSS score after treatment. Conclusion: MBI and NIHSS scores are not only indicators to evaluate the degree of illness, but also indicators to reflect the effect of nursing intervention in the acute phase of patients. There were differences in MBI and NIHSS scores before and after nursing intervention among the nursing + acupuncture treatment group, nursing + rehabilitation treatment group and nursing + combined rehabilitation group. Nursing intervention at acute stage improved the recovery effect of the patients. The treatment group and the NIHSS score before treatment were significant factors influencing the NIHSS score after treatment.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2248672
[Abstract]:Objective: To clarify the effect and influence of nursing intervention on the recovery of hemiplegic patients with ischemic stroke in acute phase, and to screen the influencing factors of the recovery effect of hemiplegic patients with ischemic stroke in acute phase, so as to provide reference for individualized nursing intervention in acute phase of ischemic stroke. Patients with hemiplegia were selected from the Department of Neurology of a Grade A hospital in Shanxi Province. Based on the current clinical routine treatment of stroke, the patients were divided into three groups according to the different nursing rehabilitation programs: nursing + acupuncture treatment group, nursing + rehabilitation treatment group and nursing + acupuncture rehabilitation combined treatment group (hereinafter referred to as nursing + rehabilitation group). Before the intervention, all patients'data were collected according to the uniformly designed Epi Data database, including demographic characteristics, living habits, past disease history and family history, laboratory tests at admission, type and location of infarction, MBI and NIHSS scores before admission, and MBI and NIH were collected again at discharge. Results: Before routine treatment and nursing intervention, nursing + acupuncture treatment group, nursing + rehabilitation treatment group and nursing + combined rehabilitation group were in general. The distribution of demographic characteristics, living habits, past disease history and family history, and laboratory tests at admission were basically balanced. There were differences in MBI and NIHSS scores between the three groups before treatment. The degree of the disease is different. the degree of the patients in the nursing + acupuncture group before treatment is much lighter than that in the nursing + rehabilitation group and the nursing + rehabilitation group. the degree of the patients in the nursing + rehabilitation group and the nursing + rehabilitation group before treatment can not be considered to be different. The MBI scores of the three groups before and after treatment were compared, F=133.237, P 0.001, indicating that the MBI scores of the patients in the different treatment groups before and after treatment were different, and the MBI scores of the patients in the nursing + acupuncture treatment group increased by a greater margin. SS score was compared, F = 70.497, P 0.001, indicating that different treatment groups before and after treatment NIHSS score difference, three groups of patients with NIHSS score changes in the range of no significant difference. The recovery effect of the nursing + rehabilitation group was better than that of the nursing + acupuncture group, the OR value was 0.403; the recovery effect of the nursing + rehabilitation group was better than that of the nursing + acupuncture group, the OR value was 9.616; the recovery effect of the nursing + rehabilitation group was better than that of the nursing + acupuncture group, the OR value was 2.235; the recovery effect of the patients with low NIHSS score before treatment was better than that of the treatment group. The patients with high NIHSS score before treatment had a better OR value of 0.126. Nursing + routine treatment group and NIHSS score before treatment were the significant factors affecting NIHSS score after treatment. Conclusion: MBI and NIHSS scores are not only indicators to evaluate the degree of illness, but also indicators to reflect the effect of nursing intervention in the acute phase of patients. There were differences in MBI and NIHSS scores before and after nursing intervention among the nursing + acupuncture treatment group, nursing + rehabilitation treatment group and nursing + combined rehabilitation group. Nursing intervention at acute stage improved the recovery effect of the patients. The treatment group and the NIHSS score before treatment were significant factors influencing the NIHSS score after treatment.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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