微信在缺血性脑卒中患者院外康复护理中的应用及效果

doi:10.3761/j.issn.1672-9234.2019.04.001

摘要/Abstract

摘要：

目的探讨微信在缺血性脑卒中患者院外康复护理中的应用方法及效果。方法 87例缺血性脑卒中出院患者完成此研究,其中,能接受微信平台干预的为试验组（45例）,其余为对照组（42例）。出院后,对照组通过电话随访接受院外康复护理,试验组在电话随访的基础上通过微信平台接受院外康复护理。在干预前、干预3个月和干预6个月时,用慢性病管理自我效能量表、改良巴氏指数量表对患者进行调查,并统计试验组应用微信平台的数据。结果干预3个月和干预6个月时,试验组慢性病管理自我效能和日常生活能力得分均高于同期对照组（P＜0.05）。微信康复指导内容阅读次数中排名前三位为疾病相关知识、恢复期和软瘫期康复训练指导。微信咨询内容中排名前三位为康复训练指导、疾病预防知识及危险因素和疾病紧急处理方案。结论基于微信平台的院外康复护理能更好地提高缺血性脑卒中患者慢性病管理自我效能和日常生活能力。

关键词: 脑缺血, 卒中, 康复护理, 远程护理, 自我效验, 日常生活活动

Abstract:

Objective To explore the effects of WeChat on rehabilitation of patients with ischemic stroke after discharge.Methods A total of 87 patients with ischemic stroke were recruited in the study. Forty-five patients who can receive the intervention through Wechat platform were assigned to the experimental group and other 42 patients were in the control group. The control group was followed up by telephone after discharge. On the basis of telephone follow-up,the experimental group applied the WeChat platform after discharge. Patients were investigated by the Self-efficacy Scale for Chronic and the Modified Barthel Index. Besides,the platform usage was also recorded.Results At 3-month and 6-month,the scores of self-efficacy of chronic disease management and activities of daily living in the experimental group were higher than those in the control group,and the difference was statistically significant. The top three contents patients were interested in were disease-related knowledge,rehabilitation training in convalescence and flaccid paralysis period. The top three contents consulted frequently were rehabilitation training,disease prevention knowledge and risk factors,and emergency coping.Conclusion Rehabilitation after discharge based on WeChat platform improves the self-efficacy and activities of daily living for patients with ischemic stroke.

Key words: Brain Ischemia, Stroke, Rehabilitation Nursing, Telenursing, Self Efficacy, Activities of Daily Living

杨明莹,王会笑,和茵,吴光柳,赵喜娟. 微信在缺血性脑卒中患者院外康复护理中的应用及效果[J]. 中华护理教育, 2019, 16(4): 245-249.

YANG Ming-ying,WANG Hui-xiao,HE Yin,WU Guang-liu,ZHAO Xi-juan. The effects of WeChat on rehabilitation of patients with ischemic stroke after discharge[J]. Chinese Journal of Nursing Education, 2019, 16(4): 245-249.

参考文献 31

[1]	Benjamin EJ, Blaha MJ, Chiuve SE , et al. Heart disease and stroke statistics-2017 update a report from the American Heart Association[J]. Circulation, 2017,135(10):e146-e603.
[2]	贾建平 . 神经病学[M]. 北京: 人民卫生出版社, 2015: 175-188.
[3]	黄如训 . 脑卒中[M]. 北京: 人民卫生出版社, 2012: 234-238.
[4]	Yang Y, Shi YZ, Zhang N , et al. The disability rate of 5-year post-stroke and its correlation factors:a national survey in China[J]. PloS One, 2016,11(11):e0165341.
[5]	程波, 袁芳 . 对脑卒中康复期患者实施延续护理的研究进展[J]. 护理学杂志, 2014,29(4):84-85.
[6]	Farris C . The teach back method[J]. Home Health Now, 2015,33(6):344-345.
[7]	吴逊 . 全国第四届脑血管病学术会议纪要[J]. 卒中与神经疾病, 1997,4(2):51-55.
[8]	Lorig K, Stewart A, Ritter P , et al. Outcome measure for health education and other health care interventions[M]. Thousand Osks,CA:Sage, 1996: 41-44.
[9]	丁岚, 马尔哈巴·吾买尔, . 网络健康管理平台对脑卒中患者自我效能及康复效果的影响[J]. 护理学报, 2015,22(1):69-71.
[10]	张旭, 单候乾, 韩雪梅 , 等. 兰州某社区慢性病患者自我效能现状及影响因素研究[J]. 中国预防医学杂志, 2018,19(2):86-90.
[11]	李雪玉, 崔蓉, 李宏伟 , 等. 军队离退休老干部慢性病患者的自我效能及影响因素[J]. 解放军护理杂志, 2015,32(14):11-15.
[12]	Shah S, Vanclay F, Cooper B . Improving the sensitivity of the Barthel Index for stroke rehabilitation[J]. J Clin Epidemiol, 1989,42(8):703-709.
[13]	Leung SO, Chan CC, Shah S . Development of a Chinese version of the Modified Barthel Index -- validity and reliability[J]. Clin Rehabil, 2007,21(10):912-922.
[14]	闵瑜, 吴媛媛, 燕铁斌 . 改良Barthel指数(简体中文版)量表评定脑卒中患者日常生活活动能力的效度和信度研究[J]. 中华物理医学与康复杂志, 2008,30(3):185-188.
[15]	闵瑜 . 改良Barthel指数(简体中文版)评定脑卒中患者的效度和信度研究[D]. 广州:中山大学, 2006.
[16]	阿尔伯特·班杜拉. 思想和行动的社会基础—社会认知论[M]. 林颖,王小明,胡谊,等译. 上海: 华东师范大学出版社, 2001.
[17]	LeBrasseur NK, Sayers SP, Ouellette MM , et al. Muscle impairments and behavioral factors mediate functional limitations and disability following stroke[J]. Phys Ther, 2006,86(10):1342-1350.
[18]	Robinson-Smith G, Johnston MV, Allen J . Self-care self-efficacy,quality of life,and depression after stroke[J]. Arch Phys Med Rehabil, 2000,81(4):460-464.
[19]	赵振华, 陈璐, 王芳 . 121例脑卒中患者出院后2周自我效能现状及影响因素分析[J]. 护理学报, 2018,25(2):54-57.
[20]	海和平, 王素琴, 王红 . 脑卒中恢复期病人自我效能的影响因素及护理措施[J]. 国际医药卫生导报, 2015,21(9):1302-1304.
[21]	林蓓蕾, 张振香, 康佳迅 , 等. 社区脑卒中患者自我效能水平影响因素及对策[J]. 中国老年学杂志, 2015,35(2):451-454.
[22]	胡剑华, 王建跃, 俞益君 , 等. “317 护”微信平台应用于脑卒中患者健康教育的效果评价[J]. 预防医学, 2018,30(3):320-322.
[23]	Frost Y, Weingarden H, Zeilig G , et al. Self-care self-efficacy correlates with independence in basic activities of daily living in individuals with chronic stroke[J]. J Stroke Cerebrovasc Dis, 2015,24(7):1649-1655.
[24]	Danks KA, Pohlig RT, Roos M , et al. Relationship between walking capacity,biopsychosocial factors,self-efficacy,and walk-ing activity in persons poststroke[J]. J Neurol Phys Ther, 2016,40(4):232-238.
[25]	倪朝民 . 神经康复学[M]. 北京: 人民卫生出版社, 2008: 43-45.
[26]	徐海, 徐奕鹏 . 本体感觉强化训练辅助静态平衡训练对脑卒中平衡能力及运动功能的影响[J]. 中国实用神经疾病杂志, 2013,16(20):11-13.
[27]	李琴, 李春花, 孙玲 , 等. 延续护理对脑卒中病人日常生活能力影响的Meta分析[J]. 护理研究, 2018,32(5A):2075-2083.
[28]	王莉, 郑红琴 . 微信平台在缺血性脑卒中患者二级预防护理中的应用[J]. 齐鲁护理杂志, 2018,24(4):10-12.
[29]	钟代曲, 蒋晓江, 曾登芬 , 等. 微信平台在出院脑卒中病人管理中的应用[J]. 护理研究, 2015,29(6A):2029-2031.
[30]	郑舟军, 刘晓虹, 张丽平 , 等. 脑卒中患者自我效能水平与其肢体功能康复进程的相关研究[J]. 中华护理杂志, 2012,47(5):440-442.
[31]	何桂霞 . 临床护理途径在急性脑卒中患者康复护理中的应用[J]. 中国实用神经疾病杂志, 2013,16(11):105-106.