程磊 潘公益

摘 要 目的：探讨社区卫生服务中心脑卒中住院患者转院的相关危险因素。方法：选取2012年4月—2014年3月在某社区卫生服务中心住院的脑卒中患者共312例，按照是否转院分为转院组79例和非转院组233例，收集患者的病史资料，并进行神经功能损伤状况评分。结果：转院组的NIHSS评分和洼田饮水试验级别与非转院组比较，差异有统计学意义（t=10.416，P=0.001；t=3.921，P=0.001）。卒中患者的高血压病、骨折、慢性支气管炎、压疮、NIHSS评分、改良MRS评分及家属陪伴患者时间减少是其发生转院的危险因素。结论：对罹患高血压、骨折、慢性支气管炎、压疮病史的脑卒中患者需进行密切监控，在患者入院时也应重点关注NIHSS、改良MRS评分等相关指标，对于评分较高者应予以重视。

关键词 脑卒中；转院；社区卫生服务中心

中图分类号：R197 文献标志码：A 文章编号：1006-1533（2018）24-0015-03

Study of the related factors of the transfer of hospitalized patients with stroke in a community in Shanghai

CHENG Lei1， PAN Gongyi2（1.General Practice Department of Ouyang Community Health Service Center of Hongkou District， Shanghai 200081， China； 2.General Practice Department of Chinese Medicine of Jiangpu Community Health Service Center of Yangpu District， Shanghai 200081， China）

ABSTRACT Objective： To explore the risk factors associated with transfer of hospitalized patients with stroke in the community health service center. Methods： All 312 hospitalized patients with stroke who were in the hospital from April 2012 to March 2014 in the community health service center were selected and according to whether referral， divided into a transferred group with 79 cases and a non-transferred group with 233 cases. The patients medical history data were collected and neurological impairment score was also assessed. Results： There were significant differences in NIHSS score and Watian drinking water test grade between the transferred group and the non-transferred group（t=10.416， P=0.001； t=3.921， P=0.001）. Hypertension， fracture， chronic bronchitis， pressure ulcer， NIHSS score， improved MRS score and reduced time that family members accompanied with patients were risk factors for the transfer of stroke patients. Conclusion： Stroke patients with hypertension， fractures， chronic bronchitis， and pressure sores need to be closely monitored. When the patients are admitted to hospital， the relevant indicators such as NIHSS and improved MRS scores should be paid attention to and for those with higher scores， attention should also be paid to.

KEY WORDS stroke； transfer； community health service center

腦卒中是临床上常见的一组综合征，包括脑梗死和脑出血，具有发病率高、死亡率高和致残率高等特点[1]。中国每年新发脑卒中患者约150万，其中70.0%～80.0%因残疾而无法独立生活[2]。因神经功能缺失而致残者约占脑卒中患者的41.0%～56.0%，这些患者需长时间在社区卫生服务中心进行康复治疗，其中部分患者因症情变化需转院治疗，这导致了患者家庭额外的经济支出，更占用了原本已很稀缺的专科医疗资源。

本研究对上海市某社区卫生服务中心2012年4月—2014年3月住院的312名脑卒中患者临床资料进行分析，探讨转院脑卒中患者的特点及相关影响因素。

1 对象与方法

1.1 研究对象