CAJ | 학술논문

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入院时其肩痛人次、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,家庭组患者再次入院时与初次出院时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.
목적 통과대주원뇌졸중편탄환자출원후적거향여공능전귀진행회고성분석,이명학뇌졸 중삼급강복적필요성.방법 이재아원접수뇌졸중강복치료출원일단시간후재차입원강복치료적뇌졸중편탄환자위연구대상,여환자출원후미전입기타강복궤구진행치료、부진행가정강복간예칙납입가정조(공유환자121례),여환자출원후계속전지기타강복궤구진행강복치료칙납입강복조(공유환자47례).대2조환자일반자료정황、출원급재차입원시Barthel지수(BI)평분、Holden보행공능분급등료효지표진행분석비교.결과 강복조환자재차입원시기견통인차、활동수한관절수량、기장력≥1+급적관건기군수량균명현소우가정조;통과상관성분석발현,가정조환자재차입원시여초차출원시BI차치여환자발병년령、합병증수량구유부상관성,여출원시BI평분、Holden보행공능분급구유정상관성;장가정조BI차치여출원시BI평분、Holden보행공능분급진행곡선회귀분석,발현여출원시BI평분≥45분,칙환자출원회가후기BI평분가유지은정,당출원시Holden보행공능분급≥2급,칙환자회귀가정후보행공능불지우퇴보.결론 뇌졸중편탄환자출원후계속접수궤구내강복치료,능진일보제고기BI평분급Holden보행공능분급,억제병발증발생;여뇌졸중환자출원시BI평분≥45분혹Holden보행공능분급≥2급,칙환자회귀가정후공능가기본유지,단환자잉수진행괄당강복간예이촉진공능회복、예방병발증발생.
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 twenty-one stroke patients discharged from the authors' department in a tertiary hospital after hospitalized rehabilitation treatment and continued with no guided rehabilitation training at home for a period of more than 15 days before readmission to the department were recruited as the family group,another 47 patients discharged from the same department and continued with hospitalized rehabilitation treatment in other institutions for a period of more than 15 days before re-admission 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 re-admission 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 re-admission 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.