颅内动脉瘤破裂出血患者延续性护理需求现状及影响因素分析

doi:10.3969/j.issn.1006-9771.2026.03.012

摘要/Abstract

摘要：

目的调查颅内动脉瘤破裂出血患者延续性护理需求状况，并分析其影响因素。

方法 2022年1月至2025年4月，选取安徽医科大学第四附属医院收治的121例颅内动脉瘤破裂出血患者，采用一般资料调查表和延续性护理需求调查表进行问卷调查。采用多元线性回归分析延续性护理需求的影响因素。

结果发出121份问卷，回收115份，有效回收率95.04%。延续性护理需求得分(100.54±6.97)分。不同年龄、受教育程度、家庭主要照顾者、术前Hunt-Hess分级、并发其他疾病数量、术后接受过康复训练、家附近有医疗卫生服务机构情况患者延续性护理需求评分比较有显著性差异(|F| > 8.104, |t| > 2.651, P < 0.05)。多元线性回归分析显示，受教育程度、家庭主要照顾者、术前Hunt-Hess分级、并发其他疾病数量、家附近有医疗卫生服务机构情况均为颅内动脉瘤破裂出血患者延续性护理需求的影响因素(|t| > 1.703, P < 0.05)。

结论颅内动脉瘤破裂出血患者延续性护理需求受教育程度、家庭主要照顾者、术前Hunt-Hess分级、并发其他疾病数量、家附近有医疗卫生服务机构情况等因素影响，医护人员应综合考虑患者具体情况与实际需求，为其提供针对性的延续性护理服务。

关键词: 颅内动脉瘤, 延续性护理需求, 影响因素

Abstract:

Objective To investigate the status and influencing factors of the continuity of care needs in patients with ruptured intracranial aneurysm hemorrhage.

Methods From January, 2022 to April, 2025, 121 patients with ruptured intracranial aneurysm hemorrhage admitted to the Fourth Affiliated Hospital of Anhui Medical University were selected. A questionnaire survey was conducted using general information questionnaire and continuity of care needs questionnaire. Multiple linear regression analysis was used to analyze the influencing factors of continuity of care needs.

Results A total of 121 questionnaires were distributed, with 115 returned (95.04%). The scores of continuity of care needs were with an average score of (100.54±6.97). Statistically significant differences were observed in scores of continuity of care needs among patients with different ages, education levels, primary family caregivers, preoperative Hunt-Hess grades, number of comorbid diseases, whether they received postoperative rehabilitation training and availability of nearby healthcare services (|F| > 8.104, |t| > 2.651, P< 0.05). Multiple linear regression analysis showed that education level, primary family caregiver, preoperative Hunt-Hess grade, number of comorbid diseases and availability of nearby healthcare services were all influencing factors for the continuity of care needs in patients with ruptured intracranial aneurysm hemorrhage (|t| > 1.703, P< 0.05).

Conclusion The need for continuous care in patients with ruptured intracranial aneurysms is influenced by factors such as educational level, primary family caregivers, preoperative Hunt-Hess grade, number of comorbid diseases and accessibility to nearby healthcare services. Medical staff should comprehensively consider patients' specific conditions and actual needs to provide targeted continuous care services.

Key words: intracranial aneurysm, continuity of care needs, influence factor

中图分类号:

R651.1

张春芹, 谢程程, 王婷婷. 颅内动脉瘤破裂出血患者延续性护理需求现状及影响因素分析[J]. 《中国康复理论与实践》, 2026, 32(3): 356-363.

ZHANG Chunqin, XIE Chengcheng, WANG Tingting. Status and influencing factors of the continuity of care needs in patients with ruptured intracranial aneurysm hemorrhage[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 356-363.

图/表 4

表1

表2

表3

表4

参考文献 42

[1]	ZHANG X H, ZHAO X Y, LIU L L, et al. Identification of ruptured intracranial aneurysms using the aneurysm-specific prediction score in patients with multiple aneurysms with subarachnoid hemorrhages: a Chinese population based external validation study[J]. BMC Neurol, 2022, 22(1): 201. doi: 10.1186/s12883-022-02727-w
[2]	程晶晶, 刘红娟. 全面早期康复护理在颅内动脉瘤夹闭术患者中的效果观察[J]. 中国肿瘤临床与康复, 2022, 29(3): 376-380.
	CHENG J J, LIU H J. Observation of the effect of comprehensive early rehabilitation nursing in patients undergoing intracranial aneurysm clipping surgery[J]. Chin J Clin Oncol Rehabil, 2022, 29(3): 376-380.
[3]	叶慧, 边雪梅. 基于IPA分析法的延续护理干预在颅内动脉瘤患者居家康复中的应用效果[J]. 检验医学与临床, 2021, 18(6): 830-833.
	YE H, BIAN X M. The application effect of continuous nursing intervention based on IPA analysis method in home rehabilitation of patients with intracranial aneurysms[J]. Med Lab Sci Clin, 2021, 18(6): 830-833.
[4]	周惠玲, 苏铭叶, 杨志玉, 等. 肝移植受者延续性护理服务需求现状和属性分析[J]. 中国护理管理, 2024, 24(11): 1738-1742.
	ZHOU H L, SU M Y, YANG Z Y, et al. Analysis of the current status and attributes of the demand for continuity of care services in liver transplant recipients[J]. Chin Nurs Manag, 2024, 24(11): 1738-1742.
[5]	张炜, 赵乐妍, 孙颖. 延续性护理在老年衰弱患者中的应用与效果评价[J]. 中国实用护理杂志, 2021, 37(26): 2016-2021.
	ZHANG W, ZHAO L Y, SUN Y. Application and effectiveness evaluation of continuity nursing in elderly patients with frailty[J]. Chin J Pract Nurs, 2021, 37(26): 2016-2021.
[6]	PIROLI A, LEUTER C, FUSCO L, et al. Diagnostic and therapeutic pathway for pain in a continuing care setting: a survey at an Italian Continuing Care Service[J]. Ann Ig, 2022, 34(1): 84-96.
[7]	武美茹, 陈义彤, 刘星池, 等. 基于掌上天坛APP卒中患者延续性护理需求的质性研究[J]. 中国卒中杂志, 2024, 19(5): 586-591.
	WU M R, CHEN Y T, LIU X C, et al. Qualitative study on the continuity of care needs of stroke patients based on the Palm Temple of Heaven APP[J]. Chin J Stroke, 2024, 19(5): 586-591.
[8]	卜文夺, 马红梅, 程惠玲, 等. 维持性血液透析患者对延续性护理需求状况及相关因素的调查分析[J]. 河北医药, 2020, 42(18): 2842-2847.
	BU W D, MA H M, CHENG H L, et al. Investigation and analysis of the demand for continuity of care and related factors in maintenance hemodialysis patients[J]. Hebei Med J, 2020, 42(18): 2842-2847.
[9]	徐婷, 董恩宏, 郭丽君, 等. 老年慢性病患者延续性健康管理需求及影响因素研究[J]. 中国全科医学, 2021, 24(13): 1665-1670. doi: 10.12114/j.issn.1007-9572.2021.00.014
	XU T, DONG E H, GUO L J, et al. Research on the needs and influencing factors of continuity of health management in elderly chronic disease patients[J]. Chin Gener Pract, 2021, 24(13): 1665-1670.
[10]	中国医师协会神经介入专业委员会, 中国颅内动脉瘤计划研究组. 中国颅内破裂动脉瘤诊疗指南2021[J]. 中国脑血管病杂志, 2021, 18(8): 546-574.
	Chinese Medical Association Neurointerventional Professional Committee, Chinese Intracranial Aneurysm Program Research Group. Chinese guidelines for diagnosis and treatment of intracranial burst aneurysms 2021[J]. Chin J Cerebrovas Dis, 2021, 18(8): 546-574.
[11]	张海洪, 丛亚丽. 世界医学会«赫尔辛基宣言»2024版修订述评[J]. 医学与哲学, 2024, 45(21): 18-23.
	ZHANG H H, CONG Y L. A review of the 2024 revision of the World Medical Association Declaration of Helsinki[J]. Med Philos, 2024, 45(21): 18-23.
[12]	NINA P, SCHISANO G, CHIAPPETTA F, et al. A study of blood coagulation and fibrinolytic system in spontaneous subarachnoid hemorrhage. Correlation with Hunt-Hess grade and outcome[J]. Surg Neurol, 2001, 55(4): 197-203. pmid: 11358585
[13]	马波. 脑卒中患者延续性护理服务需求现状及效果评价[D]. 长春: 吉林大学, 2015.
	MA B. Current situation and effectiveness evaluation of continuity of care services for stroke patients[D]. Changchun: Jilin University, 2015.
[14]	MCKAY J R. Digital approaches to continuing care[J]. Curr Opin Psychiatry, 2022, 35(4): 259-264. doi: 10.1097/YCO.0000000000000801
[15]	SU X, ZHONG M H, YE X M, et al. Effects of evidence-based continuing care bundle on health outcomes in rectal cancer patients with temporary stomas: a multicenter randomized controlled trial[J]. Cancer Nurs, 2021, 44(3): 223-234. doi: 10.1097/NCC.0000000000000762
[16]	FAKHA A, GROENVYNCK L, DE BOER B, et al. A myriad of factors influencing the implementation of transitional care innovations:a scoping review[J]. Implement Sci, 2021, 16(1): 21. doi: 10.1186/s13012-021-01087-2
[17]	LIU H, WANG Z, HU J, et al. Measuring the continuing care needs of inpatients in rural China[J]. BMC Health Serv Res, 2024, 24(1): 308. doi: 10.1186/s12913-024-10729-2 pmid: 38454448
[18]	ORTEGA MORENO D A, ALMULHIM I, KU J C, et al. Effect of non-neurological complications on the functional outcome of patients with ruptured intracranial aneurysms[J]. Neurochirurgie, 2025, 71(3): 101663. doi: 10.1016/j.neuchi.2025.101663
[19]	韩琳. 中青年脑卒中患者延续性护理需求的现状及影响因素分析[D]. 长春: 吉林大学, 2017.
	HAN L. Analysis of the current situation and influencing factors of continuity of care needs in middle-aged and young stroke patients[D]. Changchun: Jilin University, 2017.
[20]	LARSON S, JOHN S, GOWRISANKAR S, et al. Social determinants of health framework identifies patients at risk for loss to follow-up after stroke[J]. J Am Heart Assoc, 2025, 14(9): 40986.
[21]	KWAME A, PETRUCKA P M. Understanding patients' decision to leave hospital care in Ghana: clinical cases and underlying determinants[J]. BMC Nurs, 2024, 23(1): 867. doi: 10.1186/s12912-024-02469-9 pmid: 39614221
[22]	陈丽珊. 老年股骨粗隆间骨折手术患者延续性护理需求状况及其影响因素分析[J]. 护理实践与研究, 2021, 18(13): 1912-1915.
	CHEN L S. Analysis of the continuous nursing needs and influencing factors of elderly patients undergoing femoral intertrochanteric fracture surgery[J]. Nurs Pract Res, 2021, 18(13): 1912-1915.
[23]	TYLER N, HODKINSON A, PLANNER C, et al. Transitional care interventions from hospital to community to reduce health care use and improve patient outcomes: a systematic review and network meta-analysis[J]. JAMA Netw Open, 2023, 6(11): 2344825.
[24]	YOKOBATAKE K, OHTA T, KITAOKA H, et al. Safety of early rehabilitation in patients with aneurysmal subarachnoid hemorrhage: a retrospective cohort study[J]. J Stroke Cerebrovasc Dis, 2022, 31(11): 106751. doi: 10.1016/j.jstrokecerebrovasdis.2022.106751
[25]	LIU P, LI R, ZHANG T, et al. Multimodal assessment predicts cognitive impairment after aneurysmal subarachnoid hemorrhage: a prospective cohort study[J]. Int J Surg, 2025, 111(2): 1977-1987. doi: 10.1097/JS9.0000000000002239
[26]	WESSELS L, WOLF S, ADAGE T, et al. Localized nicardipine release implants for prevention of vasospasm after aneurysmal subarachnoid hemorrhage: a randomized clinical trial[J]. JAMA Neurol, 2024, 81(10): 1060-1065. doi: 10.1001/jamaneurol.2024.2564 pmid: 39158893
[27]	石砚, 曹娟. 白内障患者日间手术后延续性护理需求的相关因素[J]. 中国医药导报, 2022, 19(10): 190-193.
	SHI Y, CAO J. Related factors of continuity of care needs for cataract patients after day surgery[J]. Chin Med J, 2022, 19(10): 190-193.
[28]	赵伟霞, 高洁, 刘璋. 老年骨质疏松性骨折患者出院后对疾病和康复锻炼认知、自我护理能力以及延续护理的需求[J]. 现代中西医结合杂志, 2023, 32(6): 848-851.
	ZHAO W X, GAO J, LIU Z. Elderly patients with osteoporotic fractures have a need for disease and rehabilitation exercise awareness, self-care ability, and continuity of care after discharge[J]. Mod J Integr Tradit Chin West Med, 2023, 32(6): 848-851.
[29]	WU L T, GLASS G F J R, CHEW E Y H, et al. Developing a theory of change to guide the design and implementation of a caregiver-centric support service[J]. BMC Health Serv Res, 2024, 24(1): 1620. doi: 10.1186/s12913-024-11931-y pmid: 39695613
[30]	郭鸣, 李冰洁, 梅利平, 等. 动脉瘤性蛛网膜下腔出血患者Hunt-Hess分级与并发症及功能障碍相关性分析[J]. 神经损伤与功能重建, 2024, 19(4): 217-221.
	GUO M, LI B J, MEI L P, et al. Correlation analysis between Hunt-Hess grading, complications, and functional impairment in patients with aneurysmal subarachnoid hemorrhage[J]. Neur Injury Function Reconstruct, 2024, 19(4): 217-221.
[31]	YANG Y, WANG B, GE X, et al. Natural course of ruptured but untreated intracranial aneurysms: a multicenter 2-year follow-up study[J]. Stroke, 2023, 54(8): 2087-2095. doi: 10.1161/STROKEAHA.123.042530 pmid: 37306018
[32]	FAN M, JING L, WANG B, et al. Analysis of postoperative quality of life and prognosis of patients with intracranial aneurysm after nursing based on concept of time[J]. Am J Transl Res, 2023, 15(4): 2861-2869. pmid: 37193153
[33]	RASS V, IANOSI B A, LINDLBAUER M, et al. Factors associated with prolonged mechanical ventilation in patients with subarachnoid hemorrhage: the RAISE score[J]. Crit Care Med, 2022, 50(1): 103-113.
[34]	ZHOU H, LIU H J, WANG C, et al. Prognostic factors for anterior cerebral artery aneurysms: a single-center series[J]. J Craniofac Surg, 2024, 35(2): 167-169.
[35]	LIM Y C, LEE E, SONG J. Depression or anxiety according to management modalities in patients with unruptured intracranial aneurysms[J]. Stroke, 2022, 53(12): 3662-3670. doi: 10.1161/STROKEAHA.122.040330 pmid: 36128901
[36]	HAMMING A L, VAN DIJCK J T J M, VISSER T, et al. Study on prognosis of acutely ruptured intracranial aneurysms (SPARTA): a protocol for a multicentre prospective cohort study[J]. BMC Neurol, 2024, 24(1): 68. doi: 10.1186/s12883-024-03567-6 pmid: 38368355
[37]	CALERO-MARTINEZ S A, ABOUD N, SIMION G, et al. Self-assessment of quality of life in patients after suffering from aneurysmal subarachnoid hemorrhage, principal component analysis[J]. Sci Rep, 2025, 15(1): 25674. doi: 10.1038/s41598-025-11523-8
[38]	王琦, 张红梅, 张逍显, 等. 老年慢性病患者社区护理需求现状及影响因素[J]. 现代预防医学, 2020, 47(9): 1617-1620.
	WANG Q, ZHANG H M, ZHANG X X, et al. The current situation and influencing factors of community nursing needs for elderly patients with chronic diseases[J]. Mod Prevent Med, 2020, 47(9): 1617-1620.
[39]	郭蕾, 方琴. 慢性病患者延续性护理需求的研究进展[J]. 中华现代护理杂志, 2024, 30(13): 1809-1815.
	GUO L, FANG Q. Research progress on continuity of care needs of chronic disease patients[J]. Chin J Mod Nurs, 2024, 30(13): 1809-1815.
[40]	沈蓝君, 夏露, 程云. 老年日间手术患者延续护理需求现状及影响因素研究[J]. 中华护理杂志, 2022, 57(21): 2622-2628.
	SHEN L J, XIA L, CHENG Y. Research on the current situation and influencing factors of continued nursing needs in elderly day surgery patients[J]. Chin J Nurs, 2022, 57(21): 2622-2628.
[41]	WOO H N, LIM Y C, LEE J H, et al. Predictors of self-care performance in patients with unruptured intracranial aneurysms[J]. Sci Rep, 2024, 14(1): 30304. doi: 10.1038/s41598-024-82090-7
[42]	JONES BERKELEY S B, JOHNSON A M, MORMER E R, et al. Referral to community-based rehabilitation following acute stroke:findings from the COMPASS pragmatic trial[J]. Circ Cardiovasc Qual Outcome, 2024, 17(1): 10026.

维度	条目数	得分范围	得分
康复指导需求	8	8~40	18.27±3.31
生活护理需求	6	6~30	17.47±3.50
心理护理需求	4	4~20	13.00(11.00, 14.00)
并发症预防护理需求	5	5~25	14.00(12.00, 16.00)
专业护理需求	3	3~15	10.00(9.00, 11.00)
健康教育护理需求	6	6~30	15.27±2.54
自我护理需求	4	4~20	13.00(11.00, 15.00)
延续性护理需求总分	36	36~180	100.54±6.97

项目		n	延续性护理需求评分	F/t值	P值
年龄	≤ 40岁	24	96.83±6.57	8.183	< 0.001
	41~65岁	45	99.71±5.90
	> 65岁	46	103.28±7.17
性别	男	67	100.63±7.46	0.159	0.874
性别	女	48	100.42±6.30	0.159	0.874
受教育程度	初中及以下	34	104.00±6.86	9.559	< 0.001
	高中或中专	60	100.08±6.30
	大专及以上	21	96.24±6.49
居住地	农村	49	101.51±7.66	1.291	0.199
居住地	城镇	66	99.82±6.38	1.291	0.199
医疗付费方式	医保	97	100.62±7.02	0.282	0.778
医疗付费方式	自费	18	100.11±6.87	0.282	0.778
家庭主要照顾者	家属	85	99.34±6.61	3.227	0.002
家庭主要照顾者	自己	30	103.93±6.96	3.227	0.002
动脉瘤发生部位	前交通动脉	32	99.09±5.86	1.087	0.358
	后交通动脉	36	100.08±7.76
	大脑中动脉	23	101.96±7.95
	颈内动脉	24	101.79±5.97
动脉瘤数目	单发	74	100.35±7.62	0.387	0.700
动脉瘤数目	多发	41	100.88±5.68	0.387	0.700
术前Hunt-Hess分级	Ⅰ级	53	98.13±6.39	8.104	< 0.001
	Ⅱ级	46	101.74±6.29
	Ⅲ级	16	105.06±7.92
并发其他疾病数量	无	18	96.11±6.41	8.702	< 0.001
	1种	68	100.16±6.08
	≥ 2种	29	104.17±7.62
术后接受过康复训练	是	73	99.21±6.17	2.783	0.006
术后接受过康复训练	否	42	102.86±7.72	2.783	0.006
家附近有医疗卫生服务机构	是	85	99.54±6.56	2.651	0.009
家附近有医疗卫生服务机构	否	30	103.37±7.43

自变量	赋值
年龄	≤ 40岁 = 1，41~65岁 = 2，> 65岁 = 3
性别	男 = 1，女 = 2
受教育程度	初中及以下 = 1，高中或中专 = 2，大专及以上 = 3
居住地	农村 = 1，城镇 = 0
医疗付费方式	自费 = 1，医保 = 0
家庭主要照顾者	自己 = 1，家属 = 0
动脉瘤发生部位	前交通动脉 = 1，后交通动脉 = 2，大脑中动脉 = 3，颈内动脉 = 4
动脉瘤数目	多发 = 1，单发 = 0
术前Hunt-Hess分级	Ⅰ级 = 1，Ⅱ级 = 2，Ⅲ级 = 3
并发其他疾病	无 = 1，1种 = 2，≥ 2种 = 3
术后接受过康复训练	否 = 1，是 = 0
家附近有医疗卫生服务机构	否 = 1，是 = 0

自变量		回归系数		β	t值	P值	95%置信区间		共线性检验
自变量		B	SE	β	t值	P值	下限	上限	容差	VIF
年龄	≤ 40岁	0.000
	41~65岁	1.724	1.464	0.121	1.178	0.242	-1.181	4.630	0.519	1.927
	> 65岁	2.909	1.531	0.205	1.900	0.060	-0.130	5.948	0.471	2.125
性别	男	0.000
	女	0.773	1.131	0.055	0.683	0.496	-1.472	3.017	0.852	1.174
受教育程度	初中及以下	0.000
	高中或中专	-2.206	1.295	-0.159	-1.703	0.092	-4.777	0.365	0.632	1.581
	大专及以上	-4.120	1.751	-0.229	-2.353	0.021	-7.596	-0.645	0.579	1.728
居住地	农村	0.000
	城镇	0.102	1.120	0.007	0.091	0.927	-2.120	2.324	0.864	1.158
医疗付费方式	医保	0.000
	自费	-0.211	1.583	-0.011	-0.133	0.894	-3.353	2.932	0.800	1.250
家庭主要照顾者	家属	0.000
	自己	2.945	1.321	0.186	2.230	0.028	0.324	5.567	0.787	1.271
动脉瘤发生部位	前交通动脉	0.000
	后交通动脉	0.396	1.441	0.026	0.275	0.784	-2.464	3.255	0.593	1.686
	大脑中动脉	-0.316	1.642	-0.018	-0.192	0.848	-3.575	2.943	0.614	1.629
	颈内动脉	1.991	1.575	0.117	1.264	0.209	-1.136	5.118	0.646	1.548
动脉瘤数目	单发	0.000							0.833	1.200
	多发	-0.223	1.177	-0.015	-0.189	0.850	-2.558	2.113
术前Hunt-Hess分级	Ⅰ级	0.000							0.748	1.336
	Ⅱ级	2.478	1.214	0.175	2.041	0.044	0.068	4.887	0.735	1.361
	Ⅲ级	5.209	1.735	0.260	3.003	0.003	1.765	8.652
并发其他疾病	无	0.000							0.808	1.238
	1种	1.632	1.575	0.116	1.036	0.303	-1.495	4.759
	≥ 2种	6.328	1.775	0.396	3.565	0.001	2.804	9.851	0.852	1.173
术后接受过康复训练	是	0.000
	否	1.827	1.186	0.127	1.541	0.127	-0.527	4.181	0.812	1.232
家附近有医疗卫生服务机构	是	0.000
	否	2.783	1.294	0.176	2.150	0.034	0.214	5.353	0.819	1.220