| 李兰涛,陈汴玲,王洁,等.家庭医生制度下社区脑卒中偏瘫康复管理模式探索[J].中国临床保健杂志,2021,24(6):789-792. |
| 家庭医生制度下社区脑卒中偏瘫康复管理模式探索 |
| Exploration of rehabilitation management model for stroke patients with hemiplegia in community under family doctor system |
| 投稿时间：2020-07-27 |
| DOI：10.3969/J.issn.1672-6790.2021.06.015 |
| 中文关键词: 卒中 偏瘫 康复 社区卫生服务,家庭医生 |
| 英文关键词: Stroke Hemiplegia Rehabilitation Community health services,family doctor 〖FL |
| 基金项目:上海市长宁区科学技术委员会科研项目(NKW2014S04) |
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| 摘要点击次数: 1955 |
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| 中文摘要: |
| 目的 探索家庭医生管理下社区脑卒中偏瘫患者康复的管理模式,建立和完善社区的康复服务网络。方法 根据患者的运动功能及日常生活活动能力(ADL)评定将患者分为三类,分别进行家庭、卫生服务站和病房等不同级别的康复,分别是家庭康复训练,康复治疗师一对一定期指导；卫生服务站康复训练,康复治疗师一对多名训练；住院康复,由康复医生制定康复方案,康复治疗师一对一训练。定期运动功能评定,积分提高,回归社区和家庭,继续康复治疗；同时针对2014年136例及2015年164例住院康复患者进行观察,在同样康复治疗的基础上,对2015年的164例患者的护工进行康复技能教育,培训其指导患者生活能力的技能,并协助康复治疗师监督患者完成作业。分别对其入院及出院时进行ADL评分,比较入院及出院ADL评分提高的情况。结果 (1)记录观察病例和对照组病例3次评定简化Fugl-Meyer(FMA)运动功能积分及总提高分数,进行对比,结果应用P检验,运动功能均得到明显提高(P＜0.01),但是两组之间差异无统计学意义(P＞0.1)；记录观察病例和对照组病例3次评定ADL评分及总提高分,进行对比,结果应用P检验,日常生活能力评定均得到明显提高(P＜0.01),且两组之间差异具有明显统计学意义,观察组的提高显著高于对照组(P＜0.01)。(2)两组患者在住院时间及康复锻炼治疗无明显差异的情况下,经由接受过康复技能教育护工参与康复治疗组的患者出院ADL评分提高程度明显高于没有护工参与康复治疗组,差异有统计学意义(P＜0.01)。结论 (1)家庭医生制度下的偏瘫康复模式,在站点和家庭的康复治疗,更加注重实用性,有效性。在社区服务站和家庭进行康复训练,大大方便了患者,使其能够坚持康复训练,也使患者的长期照顾者参与程度更高。康复治疗方案中,康复动作的设计更加贴近生活能力的训练,更关注残肢功能的替代,而非仅仅是恢复,明显有利于患者回归家庭,提高患者及家庭生活质量。(2)对康复病房护工康复技能培训,可使患者的生活能力得到更大的改善,减轻家庭和社会的负担,提升患者自信及康复欲望。 |
| 英文摘要: |
| Objective To explore the management model of rehabilitation for stroke patients with hemiplegia in community under the management of family doctors and establish and improve community rehabilitation service network.Methods After receiving the information of cardio-encephalopathy,the patients were scored by the motor function scale and ADL index by the community family doctors.The patients were divided into three categories:family rehabilitation training,rehabilitation therapists′ guidance for a certain period,rehabilitation training at health service stations and rehabilitation therapists′ training for more than one in-patient rehabilitation.Rehabilitation programs were formulated by rehabilitation doctors and one-to-one training by rehabilitation therapists.At the same time,we observed 136 inpatients in 2014 and 164 inpatients in 2015.On the basis of the same rehabilitation treatment,164 nurses were educated in 2015 on rehabilitation skills to guide patients′ living ability and assisted rehabilitation therapists.The ADL scores were scored at admission and discharge,and the improvement of ADL scores at admission and discharge was compared.Results 1.The motor function of FMA was significantly improved by P test (P<0.01),but there was no significant difference between the two groups (P>0.1).With P test,the assessment of daily living ability was significantly improved (P<0.01),and there was a significant difference between the two groups.The improvement of the observation group was significantly higher than that of the control group (P<0.01).2.There was no significant difference in hospitalization time and rehabilitation exercise treatment between the two groups.The ADL scores of the patients who participated in rehabilitation treatment group through rehabilitation skill education were significantly higher than those who did not participate in rehabilitation treatment group (P<0.01).Conclusions (1)The rehabilitation model of hemiplegia under the family doctor system is obviously conducive to the return of patients to their families and improve the quality of life of patients and families.(2)Rehabilitation skills training for nurses in rehabilitation wards can greatly improve patients′ living ability,lighten the burden of family and society and enhance patients′ self-confidence and desire for rehabilitation. |
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