摘 要
目的通过自行设计的“脑卒中患者出院后延续性服务需求调查问卷”,了解脑卒中患者出院后的服务需求，根据需求现状实施延续性护理服务措施，并对扩展服务的效果给予评价，指导脑卒中患者后期康复，为节约医疗卫生资源，优化医疗资源配置，制定切实可行的医养结合政策提供一定依据。
方法对自行设计的“脑卒中患者延续性护理服务需求调查问卷”进行科学性评价，通过对问卷的项目鉴别度、信度、效度的分析，确认调查问卷的科学性。选择2014年7月--2014年9月在本院神经内科6个病区住院的脑卒中患者300例，进行需求问卷调查，了解脑卒中患者延续性护理服务需求现状。随机选择2014年9月-2014年11月在本院神经内科6个病区和1个家庭病房患者300例，将患者随机分为试验组和对照组，每组患者150例，试验组患者在入院24-48小时内即制定出院评估及出院计划，出院后接受专科医护团队的电话随访和家庭访视，对照组按神经内科常规护理，无院后访视，观察血生化指标、血压值、自理能力评分、满意度得分、再次住院患者人数等数据变化，分别于出院时、出院后1个月、出院后6个月、出院后12个月进行评估，并通过SPSS17.0统计软件进行相关统计学处理。
结果脑卒中患者出院后护理服务需求问卷各条目得分与总分的 Pearson 相关系数为 0.51~0.94（ P<0.01）；探索性因子分析中7个公因子的累计贡献率为72.37%;量表的 7 个维度 Cronbach,s α系数值均大于 0.7,总量表 Cronbach,s α系数值0.84.通过问卷，脑卒中患者出院后延续性护理服务得分为106.25±9.46分，需求比较强烈。对延续性护理服务的效果进行评价，重复测量法方差分析结果显示：
低密度脂蛋白、高密度脂蛋白、同型半胱氨酸组间差异有统计学意义；各血生化指标组内差异有统计学意义；血生化指标低密度脂蛋白、高密度脂蛋白、胆固醇、同型半胱氨酸存在交互作用。血压、自理能力（Barthel）评分及满意度得分三次测量的重复测量方差分析中除舒张压外差异均具有统计学意义（P<0.05）。不同时间点重复测量方差分析轮廓图显示：血生化指标中低密度脂蛋白、甘油三酯、胆固醇、同型半胱氨酸、血尿酸含量降低，高密度脂蛋白升高，且试验组较对照组变化明显。两组患者出院后血压不同程度下降，收缩压较舒张压下降明显，试验组较对照组下降幅度大。随出院时间延长，患者自理能力评分升高，且试验组较对照组升高幅度大；试验组患者满意度得分提高，对照组患者满意度得分下降。
患者出院后12个月再次住院人数两组间差异有统计学意义（P<0.05），试验组较对照组再次入院人数减少。
结论自行设计的“脑卒中患者延续性护理服务需求问卷”调查结果显示：脑卒中患者延续性护理服务需求处于较高水平，患者需求较强烈。通过实施延续性护理服务措施，试验组患者较对照组血生化指标明显改善，血压不同程度的降低，自理活动能力提升，减少了脑卒中再发或并发症的发生。患者满意度提高，和谐了医患关系。再次住院人数减少，减轻家属及社会的经济负担，充分利用有限的医疗资源，为制定切实可行的医养结合政策提供一定依据。
关键词：
脑卒中，延续性护理，服务需求，效果评价
Abstract
ObjectiveThrough self-designed “questionnaire of extended service demands of cerebralstroke patients after hospital discharge ”, understand the service demands of cerebralstroke patients after hospital discharge, implement extend care service measuresaccording to the situation of demand, and evaluate the effects of extension services,guide cerebral stroke patients' late rehabilitation , provide the basis to save health careresources, optimize the distribution of medical resources, formulate feasiblemedical-recuperate policy.
MethodsEvaluate self-designed “Questionnaire of extended nursing service demands ofcerebral stroke patients” scientifically, through analyzing the discrimination, reliability,validity of the questionnaire, confirm the scientific nature of the questionnaire. Select300 patients with cerebral stroke in six inpatient areas of neurology department of ourhospital in July 2014-September 2014, conduct a demand questionnaire survey,understand the demand present situation of the continuous nursing service for patientswith cerebral stroke. Select 300 patients with cerebral stroke in six inpatient areas anda familial ward of neurology department of our hospital in September 2014 -November 2014 randomly, patients were randomly divided into experimental groupand control group, 150 patients in each group, experimental group patients accepttelephone follow-up and family visits after discharge from specialized medical team,cared control group with the neurology routine nursing, no after-discharge visits,observed the variation of data of blood biochemical indexes, blood pressure values,self-care ability score, satisfaction score, the number of hospital readmission, and soon, made evaluation respectively when discharged from hospital, 1 month afterdischarge, 6 months after discharge and 12 months after discharge, and conductedstatistical processing with SPSS17.0 statistical software.
ResultsThe Pearson correlation coefficient of each entry scores and total scores ofquestionnaire of nursing service demands of cerebral stroke patients after hospitaldischarge was 0.51 ~ 0.94 （P < 0.01）； Accumulative contribution rate of 7 commonfactors in exploratory factor analysis was 72.37%. Cronbach's a coefficient values ofseven dimensions of scale were all greater than 0.7, Cronbach's a coefficient value ofthe total scale was 0.84. We can know that the score of extended nursing service ofcerebral stroke patients after hospital discharge was （106.25±9.46） points, the demandwas relatively intense.Evaluating the effect of continuous nursing service, the contentdifferences of experimental group through intervention and the control group arestatistically significant （P < 0.05） in blood biochemical indexes of low densitylipoprotein cholesterol, high-density lipoprotein cholesterol, homocysteine content indifferent time points after discharge. The blood biochemical indexes are statisticallysignificant （P < 0.05）。 There is interaction in blood biochemical indexes of lowdensity lipoprotein cholesterol, high-density lipoprotein cholesterol, homocysteinecontent. Repetitive measure analysis of variance in the differences of changes in bloodpressure, self-care ability （Barthel） score and satisfaction scores were statisticallysignificant. Repeated measures analysis of variance contour figure shows that lowdensity lipoprotein content, cholesterol, homocysteine, content elevated, high-densitylipoprotein cholesterol, content decreased. And test group change is obviously thanthe control group. The blood pressure of two groups of patients after dischargedecreased in different level. Systolic blood pressure decreased obviously thandiastolic blood pressure. With the extension of discharge time, the Barthel score ofpatients increased, and test group is higher than control group; satisfaction of testgroup increased and satisfaction of control group decreased. The difference betweenthe two groups of hospital readmission number 12 months after discharge wasstatistically significant （P < 0.05）， the number of experimental group declinedcompared with control group.
ConclusionThe survey of self-designed “questionnaire of continuous nursing servicedemands of cerebral stroke patients” shows that the level of extended demands ofpatients are intense. By extended nursing service measures after hospital discharge,blood biochemical index of experimental group patients was improved significantlythan the control group, blood pressure dropped in different degrees, ability of self-careactivities was elevated, cerebral stroke recurrence or complications were decreased.
The improvement of patient satisfaction, made doctor-patient relationship harmonious.
tThe number of readmissions reduced, eased the economic burden of family and thesociety, and provide evidence for the allocation of medical resources.
Key words:
Stroke, Extended care, Service requirement, Effect Evaluation
目 录
第 1 章 前 言
1.1 脑卒中国内现状
1.1.1 脑卒中的流行病学现状
1.1.2 脑卒中的危害
1.2 延续性护理服务
1.2.1 延续性护理服务的相关概念
1.2.2 国内外延续性护理服务发展现状
1.3 研究目的及意义
1.4 本研究的主要创新点
1.5 研究基本框架
第 2 章 脑卒中患者出院后延续性护理服务需求的调查
2.1 材料与方法
2.1.1 研究对象
2.1.2 调查工具
2.1.3 调查方法
2.1.4 统计学方法
2.2 结果
2.2.1 脑卒中患者延续性护理服务问卷的科学性评价
2.2.2 脑卒中患者出院后需求调查一般资料
2.2.3 脑卒中患者延续性护理服务需求现状及影响因素
2.3 讨 论
2.3.1 脑卒中患者延续性护理服务需求量表的科学性评价
2.3.2 脑卒中患者的人口学特征分析
2.3.3 影响脑卒中患者延续性护理服务需求的因素
2.3.4 脑卒中患者延续性护理服务需求现状分析
第 3 章 脑卒中患者出院后延续性护理服务效果评价
3.1 材料和方法
3.1.1 研究对象
3.1.2 研究方法
3.1.3 统计学方法
3.1.4 质量控制
3.2 结果
3.2.1 患者的一般资料
3.2.2 脑卒中患者延续性护理服务血生化指标比较
3.2.3 脑卒中患者延续性护理服务血压值的比较
3.2.4 脑卒中患者延续性护理服务自理能力量表评分及满意度得分比较
3.2.5 脑卒中患者延续性护理服务再入院人数比较
3.3 讨论
3.3.1 患者一般资料的分析
3.3.2 延续性护理服务对脑卒中患者血生化指标的影响
3.3.3 延续性护理服务对脑卒中患者血压的影响
3.3.4 延续性护理服务对脑卒中患者生活自理能力评分的影响
3.3.5 延续性护理服务对脑卒中患者满意度得分的影响
3.3.6 延续性护理服务对脑卒中患者再次住院人数的影响及测算
其预期产生的经济效益
第 4 章 结论
参考文献
致 谢
