李金梅 周长美 张伟伟 张婉 拾丹丹 王慧 韩洪乐

[摘要] 目的 分析對于缺血性脑卒中患者实施康复护理过程中应用临床护理路径的效果。 方法 选择2017年4～9月徐州医学院附属医院（以下简称“我院”）神经内科接收的缺血性脑卒中患者120例，采用随机数字表法将患者分为两组，每组各60例。对照组患者实施常规护理干预，以此为基础，观察组患者接受临床路径康复护理干预。采用日常生活能力评定量表（BI）分析患者日常生活能力；采用洼田实验评分表评价患者治疗前后吞咽功能；采用蒙特利尔认知评估量表（MoCA）分析患者治疗后认知情况；采用汉密顿焦虑量表（HAMA）以及汉密顿抑郁量表（HAMD）分析患者护理前后抑郁，焦虑情况；采用我院自制护理满意度量表，调查患者护理后护理满意度；分析两组病患护理前后卒中神经功能缺损（CNS）和临床痴呆分数（CDR）。 结果 护理干预后，两组患者的BI评分、洼田实验评分、MoCA评分、HAMA评分、HAMD评分和CNS评分及CDR评分均优于护理干预前，且观察组于对照组，差异有统计学意义（P < 0.05）；护理干预后，观察组护理满意率高于对照组，差异有统计学意义（P < 0.05）。 结论 在缺血性脑卒中患者康复护理工作中，应用临床路径有助于疾病转归，提升患者生命质量，值得进一步推广使用。

[关键词] 康复护理；缺血性脑卒中；护理路径；效果分析

[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0171-05

[Abstract] Objective To analyze the effect of clinical nursing pathway in the implementation of rehabilitation nursing for patients with ischemic stroke. Methods From April to September in 2017， in Department of Neurology， Affiliated Hospital of Xuzhou Medical College （"our hospital" for short）， 120 patients with ischemic stroke were selected， according to random number table method， they were divided into two groups， with 60 cases in each group. The control group was treated with routine nursing intervention， the observation group was treated clinical pathway rehabilitation nursing intervention based on control group. The Bathel index （BI） was used to analyze the daily living ability of the patients， the Vada test score was used to evaluate the swallowing function before and after treatment， the Montreal Cognitive Assessment Scale （MoCA） was used to analyze the cognitive status of the patients after treatment. The HAMA and HAMD were used to analyze the depression and anxiety before and after nursing. The self-made nursing satisfaction scale of our hospital was used to investigate the nursing satisfaction of patients after nursing， stroke neurological deficits （CNS） and clinical dementia scores （CDR） before and after nursing were analyzed. Results After nursing， the scores of BI， Vada test score， MoCA， HAMA， HAMD and CNS， CDR of two groups were better than before nusing， and these of observation group were better than those of the control group， the differences were statistically significant （P < 0.05）； after nursing， the nursing satisfaction rate of observation group was higher than that of the control group， the difference was statistically significant （P < 0.05）. Conclusion For patients with ischemic stroke， in their rehabilitation care work， the application of clinical pathways contributes to cure of the disease， improve the quality of life of patients， it is worth further use.

[Key words] Rehabilitation nursing； Ischemic stroke； Nursing pathway； Effect analysis

缺血性脑卒中是一种临床常见的脑血管疾病，这种疾病严重威胁患者生命安全，致残率高达80%以上，其中重度致残者可占据40%以上。严重影响患者生活能力，为其家庭与社会带来了沉重的负担[1]。虽说当前在临床工作中，大部分医护人员注意到了患肢功能位摆放的重要性，却没有将早期康复护理干预视为重点，且当前我国缺少一套公允性较强的康复操作指南，实际临床工作中存在盲目性，严重影响患者后续康复效果[2]。……