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学科主题: 护理学
题名:
ADL功能变化在脑卒中患者康复效果评价中的应用
作者: 廖艳芳
答辩日期: 2016-05-24
导师: 尚少梅
专业: 护理学
授予单位: 北京大学
授予地点: 北京大学护理学院
学位: 硕士
关键词: 日常生活活动能力 ; Barthel指数 ; 康复效果 ; 脑卒中
其他题名: The application of ADL function changes in rehabilitation effect evaluation of patients with stroke
分类号: R473.74
摘要:

目的:分析北京市脑卒中患者出、入院ADL功能变化和康复效益情况及影响因素,并探索ADL功能变化在脑卒中住院患者康复效果评价中的应用。

方法:采用描述性的研究设计。数据来源于北京市公共卫生信息中心,抽取2013~2014年度入住北京市二、三级医院住院天数≥30天且<180天的脑卒中患者;按照出血性和缺血性两种类型对其ADL功能变化及康复效益进行分析。数据处理与分析采用SPSS17.0软件,统计描述采用频数、率、中位数等;统计推断用卡方检验、秩和检验、logistic回归分析等方法。

结果:

1.研究对象纳入情况

从北京市公共卫生信息中心提取2013.1.1~2014.12.31期间数据,共纳入北京市101家医院5521例患者数据,其中出血性和缺血性分别为799例(14.47%)和4722例(85.53%);二级医院2495例(45.19%),三级医院3026例(54.81%)。

2.出、入院ADL功能变化和康复效益情况

出血性脑卒中患者ADL功能上升的472例(59.07%),功能不变的300例(37.55%),功能下降的27例(3.38%);缺血性脑卒中患者ADL功能上升的1938例(41.04%),功能不变的2422例(51.29%),功能下降的362例(7.67%);

出血性脑卒中患者的ADL功能获得分、ADL每天康复效率、ADL康复有效性、每千元康复效益的中位数(P25,P75)分别为10.00(0.00,30.00)、0.16(0.00,0.67)、11.11%(0.00%,41.67%)、0.20(0.00,0.78);缺血性的为0.00(0.00,10.00)、0.00(0.00,0.22)、0.00%(0.00%,22.22%)、0.00(0.00,0.30);经比较,出血性脑卒中患者ADL功能变化和康复效益情况优于缺血性脑卒中患者(p<0.001)。

3.单因素分析结果显示:脑卒中患者ADL功能变化和康复效益的影响因素有年龄、入院途径、支付方式、伴随疾病种类、入院ADL分级、康复治疗情况、入住医院级别、性别、主要诊断等(p<0.05),但两种类型脑卒中ADL功能变化和康复效益的影响因素不完全一致。

4.回归分析结果显示,对中、重度功能障碍患者出院时ADL功能能否恢复到基本自理状态的预测变量,出血性的是年龄、入院途径、入院ADL分级、伴随疾病种类;缺血性的是年龄、入院途径、入院ADL分级、入住医院级别。尽管自变量与因变量的相关强度较弱,但模型拟合优度良好,模型的预测正确率为82.3%和87.9%。

5. 全市出血性和缺血性脑卒中患者接受康复治疗的比例为62.70%和60.59%,三级医院患者接受康复治疗的比例较二级医院高(p<0.001)。控制混杂因素后对有无康复治疗患者ADL功能变化和康复效益进行比较,结果显示出、入院ADL功能变化能反应缺血性脑卒中患者有无康复治疗康复效果的差异(p<0.05),但不能反应出血性脑卒中患者有无康复治疗康复效果的差异(p≥0.05)。

结论:

2013-2014年度的数据分析结果显示脑卒中患者住院期间ADL功能有一定改善,出血性脑卒中患者功能变化和康复效益情况优于缺血性脑卒中患者,两种类型脑卒中功能变化和康复效益的影响因素具有差异;脑卒中患者住院期间进行康复治疗比例稍低,利用出、入院ADL得分在一定程度上能反映出缺血性脑卒中患者康复效果的差异,尚不能反映出血性脑卒中患者康复效果的差异,建议结合其他指标进行进一步的研究。

英文摘要:

Objective:Analyze the changes of inpatients’Activities of Daily Living(ADL) with stroke and the possible influence factors, as well as , explore how the patients’ ADL in admission and disge could be used in the rehabilitation evaluation among inpatients with stroke.

Methods: This study was a deive research. The data source was the the public health information center of Beijing, all of the stroke patients hospitalized ≥30,<180 days in secondary hospital and tertiary hospitals during 2013-2014 were included. And those samples were divided into the type of hemorrhagic stroke and the type of ischemic stroke. SPSS 17.0 was used to make the statistic analysis, for the statistical deion,frequency、ratio、median were used ,and the chi-square 、 rank-sum test 、logistic regression were for the statistical inference.

Results:

The situation of the research object included

Extracted data during the period of 2013.1.1~2014.12.31from the public health information center of Beijing, 5521 samples in 101 hospitals were included, of which 799 patients(14.47%)with hemorrhagic stroke and 4722(85.53%)with ischemic stroke;2495(45.19%) were hospitalized in secondary hospitals and 3026(54.81%) in tertiary hospitals.

The changes of ADL and cost-effectiveness of the rehabilitation

The ADL function changes of hemorrhagic stroke patients were:472 (59.07%) were increased, 300 (37.55%) were unchanged,27(3.38%) were decline; ADL function changes of ischemic stroke stroke patients were:1938 (41.04%) were increased, 2422 (51.29%) were unchanged,362(7.67%) were decline;

The median (P25, P75) of the absolut functional gain, rehabilitation efficiency, ADL recovery effectiveness, cost-effectiveness of the rehabilitation with hemorrhagic stroke patients were 10.00 (0.00, 30.00), 0.16 (0.00, 0.67) and 11.11% (0.00%, 41.67%), 0.20 (0.00, 0.78);when Ischemic were 0.00 (0.00, 10.00), 0.00 (0.00, 0.22) and 0.00% (0.00%, 22.22%), 0.00 (0.00, 0.30); the functional changes and cost-effectiveness of the rehabilitation between patients with hemorrhagic and ischemic stroke were significant different, and the patients with hemorrhagic stroke were better than patients with ischemic stroke (p<0.001).

3.According to single factor analysis,the influence factors associated with the ADL changes in patients with stroke were age, patterns of payment,types of diseases,concominant diseases,the way of admission,the classifications of ADL in admission and whether receivere habilitation treatment or not,etc(p<0.05).but the outcomes were not the same between patients with hemorrhagic stroke and ischemic stroke.

4.In the regression analysis, the efficient variables influencing the hemorrhagic stroke patients with moderate and severe whether can basically take care of themselves when disge were age , the way of admission , the classifications of ADL in admission and concominant diseases,while in ischemic stroke patients were age, the way of admission , the classifications of ADL in admission, and the classes of hospitals ; The correlations among the independent variables and the depedent variable were weaker , but the model’s goodness of fit was good,with the classification accuracy were 82.3% and 87.9%.

5. The proportions of receiving rehabilitation were 62.70%( hemorrhagic stroke )and 60.59%( ischemic stroke),and it was higher in tertiary hospitals than secondary hospitals(p<0.001).After controlling the confounding factors,the results showed the ADL changes couldn’t reflect the different rehabilitation efficacy in patients with hemorrhagic stroke (p≥0.05), but could in the patients with ischemic stroke(p<0.05).

Conclusion:

The ADL function were a certain improvement in hospitalized patients with stoke during 2013-2014,the functional recovery of inpatients with hemorrhagic stroke were better than patients with ischemic stroke,and the influence factors between two types of stoke were also different. The proportions of receiving rehabilitation were slightly lower,The ADLchanges could not reflect the different rehabilitation efficacy in patients with hemorrhagic stroke (p≥0.05), but could in the patients with ischemic stroke(p<0.05) .It’s better to consult other outcomes for further research .

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/125336
Appears in Collections:北京大学护理学院_学位论文

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作者单位: 北京大学护理学院

Recommended Citation:
廖艳芳. ADL功能变化在脑卒中患者康复效果评价中的应用[D]. 北京大学护理学院. 北京大学. 2016.
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