阮晓华

【摘要】  目的  深入了解腦卒中偏瘫患者出院后康复锻炼依从性的阻碍因素，为制订针对性的康复锻炼干预提供参考依据。方法  选取医院14例脑卒中偏瘫患者作为调查对象，通过沟通了解患者的生活习惯和作息等，收集资料，分析、汇总，将主要信息提取出来。结果  根据访谈结果，影响脑卒中偏瘫患者康复锻炼依从性因素可归纳为4个主题，分别为认知因素、心理因素、自我效能、社会支持。其中认知因素包括对疾病的认知不足、未掌握的正确功能锻炼方法；心理因素包括心理负担重、跌倒恐惧；自我效能包括自信心不足、外界因素干扰、应对重复康复锻炼的自我效能低下；社会支持包括出院后医护人员指导不足、家属参与患者康复锻炼不够、养老机构的支持需求、医保政策的支持缺乏及辅助锻炼用具缺乏。结论  脑卒中偏瘫患者出院后康复锻炼依从性受多种因素影响，主要包括患者对疾病及锻炼的认知不足；心理负担重、跌倒恐惧；对重复康复锻炼自我效能低下及信心不足；缺乏家庭及社会支持。医护人员需结合社区、养老机构，制订多学科协作式的康复方案。

【关键词】  脑卒中；偏瘫；功能锻炼； 康复护理； 依从性； 影响因素；质性研究

中图分类号  R743.3    文献标识码  A    文章编号  1671-0223（2023）15--04

Interview based investigation and analysis of factors affecting rehabilitation exercise compliance in stroke patients with hemiplegia  Ruan Xiaohua. Department of Neurology， Yizhou District People's Hospital， Hechi 546300， China

【Abstract】  Objective  Thoroughly understand the obstacles to rehabilitation exercise compliance of stroke hemiplegic patients after discharge， and provide reference basis for formulating targeted rehabilitation exercise interventions. Methods  Totally 14 patients with stroke and hemiplegia in the hospital were selected as the survey subjects. Through communication and understanding of the patient's lifestyle and rest habits， data was collected， analyzed， and summarized， and the main information was extracted. Results  According to the interview results， the factors that affect the rehabilitation exercise compliance of stroke hemiplegic patients can be summarized into four themes， namely cognitive factors， psychological factors， self-efficacy， and social support. Among them， cognitive factors include insufficient understanding of the disease and inadequate mastery of correct functional exercise methods; Psychological factors include heavy psychological burden and fear of falling; Self efficacy includes insufficient self-confidence， external factors interference， and low self-efficacy in coping with repeated rehabilitation exercises; Social support includes insufficient guidance from medical staff after discharge， insufficient participation of family members in patient rehabilitation exercises， support needs from elderly care institutions， lack of support from medical insurance policies， and a lack of auxiliary exercise equipment. Conclusion  The compliance of stroke hemiplegic patients with rehabilitation exercise after discharge is influenced by various factors， mainly including insufficient understanding of the disease and exercise; Heavy psychological burden and fear of falling; Low self-efficacy and lack of confidence in repetitive rehabilitation exercises; Lack of family and social support. Medical staff need to develop a multidisciplinary and collaborative rehabilitation plan in conjunction with the community and elderly care institutions.

【Key words】  Stroke; Hemiplegia; Functional exercise; Rehabilitation care; Compliance; Influencing factors; Qualitative research

脑卒中偏瘫患者在出院后，需坚持功能锻炼，功能锻炼对康复有很好的帮助作用[1]。康复训练是漫长的，需要长期坚持，要求康复师不间断、多次强制性锻炼来形成肌肉记忆。……