《中国康复理论与实践》

《中国康复理论与实践》 ›› 2017, Vol. 23 ›› Issue (1): 106-109.doi: 10.3969/j.issn.1006-9771.2017.01.025

• 临床研究 • 上一篇    下一篇

急性脑卒中患者出院后去向及转诊的影响因素

屠建莹, 任筱舒, 陆博逊   

  1. 首都医科大学附属北京世纪坛医院神经内科,北京市 100038
  • 收稿日期:2016-10-07 出版日期:2017-01-20 发布日期:2017-02-17
  • 作者简介:屠建莹(1972-),女,汉族,浙江黄岩市人,硕士,副主任医师,主要研究方向：脑卒中的早期康复治疗、脑胶质瘤康复辅助治疗。E-mail: tujyy@sina.com。

Factors Impacting Whereabouts and Referral in Patients with Acute Stroke after Discharge

TU Jian-ying, REN Xiao-shu, LU Bo-xun   

  1. Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2016-10-07 Published:2017-01-20 Online:2017-02-17
  • Contact: TU Jian-ying. E-mail: tujyy@sina.com

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摘要： 目的 研究脑卒中患者在综合医院完成急性期治疗后,后续康复机构选择及相关影响因素。方法 回顾2015年1月至12月急性期脑卒中患者230例,探讨年龄、首次出院时改良Rankin量表(mRS)评分、转诊机构选择等因素对转诊选择的影响。结果 共125例有转诊需求。mRS恶化,转诊需求增高(P<0.05)。在转诊患者中,mRS 0~1分及2~3分患者对延续康复的需求高(F=4.300, P<0.05);mRS 4~5分组对医疗质量(F=3.464, P<0.05)和对住院时长要求高(F=3.692, P<0.05)。≥80岁组对医疗质量要求更高(F=4.630, P<0.05)。在本院继续治疗者更关注延续康复治疗(F=7.590, P<0.001),选择康复专科机构者更关注康复质量(F=32.156, P<0.001),选择社区和养老机构者则更多考虑住院时长(F=18.823, P<0.001)和方便照料(F=14.070, P<0.001)等。转诊医疗机构的信息来源于医生占72.0%,来源于患者占28.0%。结论 脑卒中急性期患者的功能障碍程度、年龄、对最终预后的预期影响对转诊的选择。医方掌握更多的康复医疗资源,在转诊过程中可给患方提供更为合理的建议。

关键词: 脑卒中, 康复, 转诊, 影响因素

Abstract: Objective To study the selection of the follow-up care and related factors in stroke patients after acute treatment in general hospital. Methods A total of 230 acute stroke patients discharged from January to December, 2015, were reviewed. They were classified with age, modified Rankin Scale (mRS) score, referral options, etc., and the key consideration in the selection were compared. Results There were 125 patients needing referral. Referral increased while mRS worsening (P<0.05). The demand for the continuation of rehabilitation was higher in the patients with mRS scores of 0-1 and 2-3 than that of 4-5 (F=4.300, P<0.05), but the latter cared more about medical quality (F=3.464, P<0.05) and hospitalization length (F=3.692, P<0.05). The patients more than 80 years old cared more about medical quality (F=4.630, P<0.05). The patients selecting continuous treatment in our hospital paid more attention on continuation (F=7.590, P<0.001), while those selecting rehabilitation institutions cared more about rehabilitation capacity (F=32.156, P<0.001), and those selecting community hospitals or nursing home cared more about hospitalization length (F=18.823, P<0.001), easy to visit (F=14.070, P<0.001), etc. Referral information mainly came from the doctors (72.0%), only 28.0% from the patients. Conclusion Severity of disability, age and the prognosis may impact the choice for the following rehabilitation in acute stroke patients. Doctors can do more for reasonable referral recommendations to the patients.

Key words: stroke, rehabilitation, referral, related factors

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