Construction and application of a traditional Chinese medicine continuing care program for patients with acute ischemic stroke

doi:10.3761/j.issn.0254-1769.2021.08.001

Abstract

Abstract:

Objective To construct a traditional Chinese medicine（TCM） continuous care program and to evaluate its application effect in discharged patients with acute ischemic stroke. Methods A total of 102 patients with acute ischemic stroke hospitalized in the Department of Encephalopathy of a tertiary hospital in Guangxi from June 2019 to June 2020 were selected as the research subjects by convenience sampling method. They were randomly allocated into an experimental group（n=51） and a control group（n=51）.The experimental group was carried out with the TCM continuous care program on the basis of routine nursing,while the control group received the routine nursing. At the time of discharge and 1 month,2 months and 3 months after discharge,the 2 groups of patients were investigated and evaluated by a simple Fugl-Meyer Assessment Scale（FMA） and Stroke Specific Quality of Life Scale（SS-QOL）. Results There was no significant difference in FMA score and SS-QOL score between the experimental group and the control group at the time of discharge（P>0.05）. A month after discharge,there was no significant difference in the FMA score between the experimental group and the control group（P>0.05）,but the SS-QOL score in the experimental group was higher than that in the control group（P<0.05）.The scores of FMA and SS-QOL in experimental group were significantly higher than those in the control group at 2 and 3 months after discharge（P<0.05）. 3 months after discharge,the clinical efficacy of the experimental group was significantly better than that of the control group（P<0.05）. The analysis of variance of repeated measurement data showed that the interaction between groups,time,and inter-groups and time had statistically significant effects on FMA score and SS-QOL score（P<0.05）. Conclusion The constructed TCM continuous care program is scientific and feasible,which can effectively improve the limb motor function of patients with acute ischemic stroke and improve their quality of life at home.

Key words: Stroke, Continuing Care Program, Inventory Management, Traditional Chinese Medicine Nursing Care

摘要：

目的构建中医延续性护理方案并评价其在急性缺血性脑卒中出院患者中的应用效果。方法采用便利抽样法,选取2019年6月—2020年6月在广西壮族自治区某三级甲等医院脑病科住院的急性缺血性脑卒中患者102例作为研究对象,随机分为试验组（n=51）和对照组（n=51）。试验组在常规护理的基础上实施中医延续性护理方案,对照组实施常规护理。两组于出院时,出院后1个月、2个月和3个月,分别采用简式Fugl-Meyer运动功能评估量表（Fugl-Meyer Assessment,FMA）、脑卒中专门化生活质量表（Stroke specific quality of life scale,SS-QOL）进行评估。结果出院时,试验组FMA评分、SS-QOL评分与对照组相比,差异无统计学意义（P>0.05）;出院后1个月,试验组FMA评分与对照组相比,差异无统计学意义（P>0.05）,SS-QOL评分试验组高于对照组（P<0.05）;出院后2个月和3个月,试验组FMA评分、SS-QOL评分均显著高于对照组（P<0.05）;重复测量方差分析显示,组间、时间、组间与时间的交互作用对FMA评分、SS-QOL评分的影响具有统计学意义（P<0.05）。结论该研究构建的中医延续性护理方案具有一定的科学性和可行性,可有效改善急性缺血性脑卒中患者的肢体运动功能,提高其生活质量。

关键词: 脑卒中, 延续护理方案, 清单式管理, 中医护理

JIN Jie,ZHONG Meirong,YU Xiuting,YANG Tiantian,FAN Kuiyu,HUANG Xiaojie. Construction and application of a traditional Chinese medicine continuing care program for patients with acute ischemic stroke[J]. Chinese Journal of Nursing, 2021, 56(8): 1125-1132.

金婕,钟美容,于秀婷,杨甜甜,范葵钰,黄小洁. 急性缺血性脑卒中患者中医延续性护理方案的构建与应用研究[J]. 中华护理杂志, 2021, 56(8): 1125-1132.

Figures/Tables 3

References 22

[1]	《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告2019》概要[J]. 中国脑血管病杂志, 2020, 17(5):272-281.
	Writing Group of Report on Stroke Prevention and Treatment in China. Brief report on stroke prevention and treatment in China,2019[J]. Chin J Cerebrovasc Dis, 2020, 17(5):272-281.
[2]	Wang WZ, Jiang B, Sun HX, et al. Prevalence,incidence,and mortality of stroke in China:results from a nationwide population-based survey of 480 687 adults[J]. Circulation, 2017, 135(8):759-771. DOI URL
[3]	郝子龙, 刘鸣, 李伟, 等. 成都卒中登记方法及3123例患者基本特征和功能结局[J]. 中华神经科杂志, 2011, 44(12):826-831.
	Hao ZL, Liu M, Li W, et al. Basic characteristics and functional outcomes of 3123 consecutive patients in Chengdu stroke registry[J]. Chin J Neurol, 2011, 44(12):826-831.
[4]	焦建余, 王珅, 黄东锋, 等. 脑卒中患者出院准备服务与照顾者照顾能力关系的探讨[J]. 中国康复医学杂志, 2005, 20(6):461-463.
	Jiao JY, Wang S, Huang DF, et al. The relationship between discharge preparation service and caregivers’ competence in patients with stroke[J]. Chin J Rehabil Med, 2005, 20(6):461-463.
[5]	王飞, 陈晓云, 闫秀琴, 等. 延续护理对脑卒中患者康复效果的随机对照试验[J]. 中国实用护理杂志, 2016, 32(19):1457-1461.
	Wang F, Chen XY, Yan XQ, et al. Effect of extended care on the rehabilitation of discharged stroke patients:a randomized controlled trial[J]. Chin J Pract Nurs, 2016, 32(19):1457-1461.
[6]	阮婷婷, 皮希凤, 黄静. 基于德尔菲法的脑卒中延续性护理服务内容指标体系的构建[J]. 护理研究, 2019, 33(22):3849-3853.
	Ruan TT, Pi XF, Huang J. Construction of the index system of stroke continuing nursing service based on Delphi method[J]. Chin Nurs Res, 2019, 33(22):3849-3853.
[7]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4):246-257.
	Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol, 2015, 48(4):246-257.
[8]	国家中医药管理局脑病急症科研组. 中风病诊断与疗效评定标准(试行)[J]. 北京中医药大学学报, 1996, 19(1):55-56.
	Encephalopathy Emergency Research Group, National Administration of Traditional Chinese Medicine. Criterion of diagnosis and therapeutic effect of apoplexy[J]. J Beijing Univ Tradit Chin Med, 1996, 19(1):55-56.
[9]	邢双双, 顾则娟, 蒋秀美, 等. 急性白血病临床护理质量评价标准的构建[J]. 中华护理杂志, 2018, 53(3):324-329.
	Xing SS, Gu ZJ, Jiang XM, et al. Construction of nursing quality evaluation index system for acute leukemia based on Structure-Process-Outcome model[J]. Chin J Nurs, 2018, 53(3):324-329.
[10]	高谦, 卓大宏. 一种新的脑卒中患者运动功能评测方法:简化Fugl-Meyer运动功能评测表的制订[J]. 中国康复医学杂志, 1994, 9(6):244-249.
	Gao Q, Zhuo DH. A new assessment chart of motor function for CVA patients:development of simplified FMA[J]. Chin J Rehabi Med, 1994, 9(6):244-249.
[11]	陈瑞全, 吴建贤, 沈显山. 中文版Fugl-Meyer运动功能评定量表的最小临床意义变化值的研究[J]. 安徽医科大学学报, 2015, 50(4):519-522.
	Chen RQ, Wu JX, Shen XS. A research on the minimal clinically important differences of Chinese version of the Fugl-Meyer Motor Scale[J]. Acta Univ Med Anhui, 2015, 50(4):519-522.
[12]	王伊龙, 马建国, 李军涛, 等. 脑卒中生存质量量表中译本信度和效度及敏感度的初步研究[J]. 中华老年心脑血管病杂志, 2003, 5(6):391-394.
	Wang YL, Ma JG, Li JT, et al. The study on reliability,validity and responsiveness of the Chinese version of Stroke-specific Quality of Life[J]. Editor Dep Chin J Geriatr Cardiovasc Cerebrovasc Dis, 2003, 5(6):391-394.
[13]	吴莹玉, 黄霞, 贾培培, 等. 护士工作场所暴力防范培训体系的构建[J]. 中华护理杂志, 2020, 55(4):584-589.
	Wu YY, Huang X, Jia PP, et al. Development of a nurse training indicator system against workplace violence based on behavioral objectives theory[J]. Chin J Nurs, 2020, 55(4):584-589.
[14]	王芳, 张丹. 中医特色延续护理对脑卒中病人出院后生存质量和满意度的影响[J]. 护理研究, 2017, 31(24):3003-3005.
	Wang F, Zhang D. Influence of continuity of care with traditional Chinese medicine characteristics on quality of life and satisfaction of stroke patients after discharge[J]. Nurs Res China, 2017, 31(24):3003-3005.
[15]	Bushnell CD, Zimmer LO, Pan WQ, et al. Persistence with stroke prevention medications 3 months after hospitalization[J]. Arch Neurol, 2010, 67(12):1456-1463. DOI URL
[16]	杨露宁, 杨嘉文, 潘丽明, 等. 医院-家庭(H-H)延续护理对肝癌患者心理状态、治疗依从性及生活质量的影响[J]. 国际护理学杂志, 2020, 39(24):4428-4431.
	Yang LN, Yang JW, Pan LM, et al. The effect of Hospital-home(H-H) continuous nursing on the mental state,treatment compliance and quality of life of patients with liver cancer[J]. Int J Nurs, 2020, 39(24):4428-4431.
[17]	胡昌盛, 许星莹, 张彩霞, 等. 缺血性脑卒中二级预防中医特色护理干预效果研究[J]. 护士进修杂志, 2020, 35(11):961-964,969.
	Hu CS, Xu XY, Zhang CX, et al. Study on the effect of traditional Chinese medicine nursing intervention on secondary prevention of ischemic stroke[J]. J Nurses Train, 2020, 35(11):961-964,969.
[18]	林红霞, 陈汝文, 钟志国. 中药足浴联合穴位按摩治疗中风后失眠的效果观察[J]. 中华现代护理杂志, 2013, 19(7):805-807.
	Lin HX, Chen RW, Zhong ZG. Observation on the effect of foot bath combined with acupoint massage on insomnia after apoplexy[J]. Chin J Mod Nurs, 2013, 19(7):805-807.
[19]	贾瑞芝, 李文会. 艾灸联合针刺治疗缺血性脑卒中后运动功能障碍临床研究[J]. 中医学报, 2017, 32(5):891-894.
	Jia RZ, Li WH. Clinical study of moxibustion combined with acupuncture in treatment of motor dysfunction after stroke[J]. Acta Chin Med, 2017, 32(5):891-894.
[20]	吴小芬, 林如, 冯锦绣, 等. 经络穴位拍打对缺血性脑卒中恢复期偏瘫患者康复的影响[J]. 按摩与康复医学, 2018, 9(4):35-37.
	Wu XF, Lin R, Feng JX, et al. Effect of meridian acupoint pat on rehabilitation of hemiplegia patients in convalescent period of ischemic stroke[J]. Chin Manip Rehabil Med, 2018, 9(4):35-37.
[21]	米硕, 史木子. 浅谈“五音疗法”[J]. 中医临床研究, 2019, 11(29):12-14.
	Mi S, Shi MZ. Discussion on the therapy of Wuyin[J]. Clin J Chin Med, 2019, 11(29):12-14.
[22]	罗媛媛, 安丙辰, 郑洁皎. 八段锦在脑卒中康复中的应用进展[J]. 中国康复理论与实践, 2019, 25(9):1057-1059.
	Luo YY, An BC, Zheng JJ. Advance in baduanjin for rehabilitation of stroke(review)[J]. Chin J Rehabi Theory Pract, 2019, 25(9):1057-1059.