多学科团队协作的延续性干预对急性脑卒中患者焦虑抑郁情绪及康复的影响Effect of continuous intervention of multidisciplinary team cooperation on anxiety and depression and rehabilitation of patients with acute stroke
姜虹;赵青华;杨水利;张楚珺;马宁;黄荣;乔盼盼;
摘要(Abstract):
目的探讨多学科团队协作的延续性干预对急性脑卒中患者焦虑抑郁情绪及康复的影响。方法回顾性纳入河南大学第一附属医院2016-01—2019-12收治的急性脑梗死患者96例。根据护理干预方式的不同分为常规护理组和多学科团队协作延续性干预组(干预组)。比较2组患者干预前后焦虑、抑郁和预后情况,比较2组患者干预3个月后并发症发生情况。结果干预前常规护理组和多学科团队协作延续性干预组患者焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分比较无显著差异(P>0.05)。干预后常规护理组和干预组SAS评分和SDS评分均较干预前明显降低,差异有统计学意义(P<0.001);干预后干预组SAS评分(40.7±3.8 vs 48.6±4.7)和SDS评分(42.3±5.3 vs 52.4±6.3)明显低于常规护理组,差异有统计学意义(P<0.05)。干预前常规护理组和干预组患者日常生活活动能力评估量表(ADL)评分和美国国立卫生研究院卒中量表(NIHSS)评分比较无显著差异(P>0.05)。干预后常规护理组和干预组患者ADL评分明显增加,NIHSS评分明显降低,与干预前比较差异有统计学意义(P<0.001)。与常规护理组干预后比较,干预组干预后ADL评分明显升高(89.6±5.7 vs 79.8±5.6),NIHSS评分明显降低(15.1±2.3 vs 19.7±2.4),差异均有统计学意义(P<0.05)。干预3个月干预组发症发生率明显低于常规护理组(3.92%vs 17.78%),差异有统计学意义(χ2=4.919,P=0.027)。结论对脑卒中患者实施多学科团队协作延续性干预,可有效改善患者的焦虑、抑郁情绪,提高其生存质量,改善神经功能,增强自理能力,减少并发症发生,全面改善患者预后。
关键词(KeyWords): 急性脑卒中;多学科团队协作;护理干预;延续性护理;焦虑;抑郁
基金项目(Foundation): 开封市科技发展计划项目(编号:1804016)
作者(Authors): 姜虹;赵青华;杨水利;张楚珺;马宁;黄荣;乔盼盼;
参考文献(References):
- [1]WU C,ZOU G,CHEN M,et al.Perceived challenges in delivering comprehensive care for patients following stroke:a qualitative study of stroke care providers in Guangdong Province,China[J].Disabil Rehabil,2020Apr 28:1-9.DOI:10.1080/09638288.2020.1755896.
- [2]LANGHORNE P,RAMACHANDRA S,Stroke Unit Trialists'Collaboration.Organised inpatient(stroke unit)care for stroke:network meta-analysis[J].Cochrane Database Syst Rev,2020,4(4):CD000197.DOI:10.1002/14651858.CD000 197.pub4.
- [3]RAC V E,SAHAKYAN Y,FAN I,et al.The characteristics of stroke units in Ontario:a pan-provincial survey[J].BMC Health Serv Res,2017,17(1):154.DOI:10.1186/s12913-017-2099-1.
- [4]ABDUL AZIZ A F,MOHD NORDIN N A,ALI M F,et al.The integrated care pathway for post stroke patients(i Ca PPS):a shared care approach between stakeholders in areas with limited access to specialist stroke care services[J].BMC Health Serv Res,2017,17(1):35.DOI:10.1186/s12913-016-1963-8.
- [5]DEBAUN M R,KING A A.Prevention of central nervous system sequelae in sickle cell disease without evidence from randomized controlled trials:the case for a team-based learning collaborative[J].Hematology Am Soc Hematol Educ Program,2016,2016(1):632-639.DOI:10.1182/asheducation-2016.1.632.
- [6]PRABHAKARAN S,LEE J,O'NEILL K.Regional Learning Collaboratives Produce Rapid and Sustainable Improvements in Stroke Thrombolysis Times[J].Circ Cardiovasc Qual Outcomes,2016,9(5):585-592.DOI:10.1161/CIRCOUTCOMES.116.003222.
- [7]LIBERATI E G,GORLI M,SCARATTI G.Invisible walls within multidisciplinary teams:Disciplinary boundaries and their effects on integrated care[J].Soc Sci Med,2016,150:31-39.DOI:10.1016/j.socscimed.2015.12.002.
- [8]DWORZYNSKI K,RITCHIE G,PLAYFORD E D.Stroke rehabilitation:long-term rehabilitation after stroke[J].Clin Med(Lond),2015,15(5):461-464.DOI:10.7861/clinmedicine.15-5-461.
- [9]鲁宗兰.早期心理干预在脑卒中后抑郁患者康复中的作用[J].中国实用神经疾病杂志,2016,19(16):112-113.
- [10]AADAL L,PALLESEN H,ARNTZEN C,et al.Municipal Cross-Disciplinary Rehabilitation following Stroke in Denmark and Norway:A Qualitative Study[J].Rehabil Res Pract,2018,2018:1972190.DOI:10.1155/2018/1972190.
- [11]SANDIUMENGE A,RAMíREZ-ESTRADA S,MAZOC,et al.Donor referral from outside the intensive care unit:A multidisciplinary cooperation model using communication apps and redefining refereal criteria[J].Med Intensiva,2020,44(3):142-149.DOI:10.1016/j.medin.2018.08.009.
- [12]RAPARELLI V,PROIETTI M,ROMITI G F,et al.The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease:Insights From EVA Study[J].Front Endocrinol(Lausanne),2019,10:107.DOI:10.3389/fendo.2019.00107.
- [13]BASARABA J E,PICARD M,GEORGE-PHILLIPSK,et al.Pharmacists as Care Providers for Stroke Patients:A Systematic Review[J].Can J Neurol Sci,2018,45(1):49-55.DOI:10.1017/cjn.2017.233.
- [14]MUNCE S E P,GRAHAM I D,SALBACH N M,et al.Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial[J].BMC Health Serv Res,2017,17(1):440.DOI:10.1186/s12913-017-2389-7.
- [15]REEVES S,PELONE F,HARRISON R,et al.Interprofessional collaboration to improve professional practice and healthcare outcomes[J].Cochrane Database Syst Rev,2017,6(6):CD000072.DOI:10.1002/14651858.CD000072.pub3.
- [16]THRELKELD Z D,KOZAK B,MCCOY D,et al.Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital[J].J Stroke Cerebrovasc Dis,2017,26(7):1500-1505.DOI:10.1016/j.jstrokecerebrovasdis.2017.03.004.
- [17]PIRONI L,CORCOS O,FORBES A,et al.Intestinal failure in adults:Recommendations from the ESPENexpert groups[J].Clin Nutr,2018,37(6 Pt A):1798-1809.DOI:10.1016/j.clnu.2018.07.036.
- [18]LIU L,LI H Z,CHEN C,et al.Application of activities of daily living scale in mild psychiatric impairment assessment[J].Fa Yi Xue Za Zhi,2018,34(1):44-48.
- [19]WANG H,CHANG H.Association study between serum uric acid and 25-hydroxy vitamin D level and acute ischemic post-stroke depression[J].Chin J Coal Ind Med,2017,20(11):1314-1317.
- [20]NISHITANI N,KAWASAKI Y,SAKAKIBARA H.Insomnia and depression:risk factors for development of depression in male Japanese workers during 2011-2013[J].Int J Public Health,2017:1-7.
- [21]TAMURA H,NISHIDA T,TSUJI A,et al.Association between excessive use of mobile phone and insomnia and depression among Japanese adolescents[J].Int JEnviron Res Public Health,2017,14(7):701.
- [22]ZHANG J Z,LI X Z,XU Y Z,et al.Application of a multidisciplinary enhanced recovery after surgery pathway to improve patient outcomes[J].Chin Nurs Manag,2018,18(4):546-662.
- [23]XU P P.Effects of team rehabilitation model in patients with post-stroke depression[D].Wuhan:Hubei University of Medicine,2018.
- [24]DAI Y Q,LIN L F,XU H J.Application of multidisciplinary team assistance mode in hospice care[J].Unrsing Prac Res,2018,16(1):108-110.
- [25]JIA W D.Multidisciplinary team building in enhanced recovery after surgery[J].Zhonghua Wai Ke Za Zhi,2018,56(1):14-17.
- [26]CLARKE H,VOSS M.The role of a multidisciplinary student team in the community management of chronic obstructive pulmonary disease[J].Prim Health Care Res Dev,2016,17(4):415-420.
- [27]CO C O C,YU J R T,MACROHON-VALDEZ M C,et al.Acute stroke care algorithm in a private tertiary hospital in the Philippines during the COVID-19 pandemic:A third world country experience[J].J Stroke Cerebrovasc Dis,2020,29(9):105059.DOI:10.1016/j.jstrokecerebrovasdis.2020.105059.
- [28]MULLINS N.Nutrition and hydration management among stroke patients in inpatient rehabilitation:a best practice implementation project[J].Int J Evid Based Healthc,2020 Jul 17.DOI:10.1097/XEB.0000000000000244.
- [29]NI X,LIN H,LI H,et al.Evidence-based practice guideline on integrative medicine for stroke 2019[J].JEvid Based Med,2020,13(2):137-152.DOI:10.1111/jebm.12386.
- [30]KONDAPALLI L,WORTH S,HAWI R,et al.Collaborative cardiovascular management of patients with chronic myeloid leukemia on tyrosine kinase inhibitors[J].Vasc Med,2020,25(3):246-254.DOI:10.1177/1358863X20906868.
- [31]RANFORD J,ASIELLO J,CLOUTIER A,et al.Interdisciplinary Stroke Recovery Research:The Perspective of Occupational Therapists in Acute Care[J].Front Neurol,2019,10:1327.DOI:10.3389/fneur.2019.01327.
- [32]CHAHAL J K,ANTONIOU S,EARLEY M,et al.Preventing strokes in people with atrial fibrillation by improving ABC[J].BMJ Open Qual,2019,8(4):e000783.DOI:10.1136/bmjoq-2019-000783.
- [33]ERIKSSON C,ERIKSSON G,JOHANSSON U,et al.Occupational therapists.perceptions of implementing a client-centered intervention in close collaboration with researchers:A mixed methods study[J].Scand J Occup Ther,2020,27(2):142-153.DOI:10.1080/11038128.2019.1573917.
- [34]SUAREZ J I,SHEIKH M K,MACDONALD R L,et al.Common Data Elements for Unruptured Intracranial Aneurysms and Subarachnoid Hemorrhage Clinical Research:A National Institute for Neurological Disorders and Stroke and National Library of Medicine Project[J].Neurocrit Care,2019,30(Suppl 1):4-19.DOI:10.1007/s12028-019-00723-6.