【作者】 杨媛；

【导师】 尹岭；

【作者基本信息】 中国人民解放军军医进修学院 ， 神经病学， 2009， 博士

【摘要】 随着社会经济的进步,医疗卫生事业的发展,人口总体的健康状况不断提高。人的健康状况除了先天原因以外,与其自身健康意识、饮食结构、生活方式、收入水平、医疗条件等密切相关。本研究针对急性脑梗死患者恢复期的健康状况及汶川地震灾区居民灾后心理应激状态下的心理健康状况进行综合的流行病学调查研究,以期更合理地配置利用卫生资源,使有限的卫生资源发挥最大的经济和社会效益,最终为制定让社会、家庭以及患者个体受益的医疗模式提供可靠的循证医学依据。1.脑卒中是当前严重危害人类生命与健康的常见病,给社会及个人带来了沉重的经济和精神负担。目前,对患者疗效的判定和衡量尚有争议,为了实现对患者治疗后健康状况的总体判断,本研究采用美国国立卫生院脑卒中量表和脑卒中专门化生存质量量表对急性脑梗死患者恢复期神经功能缺损及生存质量进行综合评定,全面描述患者健康状况,并对影响生存质量和神经功能缺损的因素进行分析,旨在改善患者预后健康状况,提高生活质量,为进一步指导脑卒中的临床治疗和患者就医提供循证医学证据。针对急性脑梗死患者恢复期健康状况的调查结果显示急性脑梗死患者恢复期生存质量普遍下降,表现为患病后的生活空间缩小、社会劳动力损失、存在一定精神压力,为家庭和社会带来更多的疾病负担;就诊于不同等级医院(二甲或二甲以上)的急性脑梗死患者恢复期生存质量没有明显差别,提示患者可就近选择二甲或相当水平及以上的医院就医,为尽早接受治疗争取时间。患者发病后越早治疗恢复越好,生存质量越高,提示患者发病后应及时接受诊治;针对不同发病部位的急性脑梗死患者,调查结果提示临床医生可以相对控制脑梗死患者的治疗费用,尽量减少患者因病所带来的经济负担:临床医生采用不同治疗措施,患者神经功能恢复程度无明显差异,提示可选择一般临床通用的治疗脑梗死药品,尽量减少患者因病所带来的经济负担。本研究对急性脑梗死患者和临床医生均具有有益的启示,并可以为政府及相关部门的政策制定提供可靠的循证医学证据。一方面,对患者而言,应采取就近治疗原则,选择附近二甲或相当水平及以上的医院及时就医,盲目向大型综合医院求医对急性脑梗死患者恢复期生存质量并没有显著提高。另一方面,临床医生在治疗过程中应以病情的实际发展需要为根据来制定临床治疗方案,选择低成本治疗方案,降低脑梗死患者的经济负担。同时应注重对患者的心理、情感和精神等方面给予积极引导,减少患者在就医治疗过程中的精神压力,这对患者的整体康复和早期融入家庭、社会具有积极的作用。2.2008年汶川特大地震除了给国家、灾区居民的生命财产造成了重大损失,还对居民的生活和健康状况产生严重影响,特别是心理状况在较短时期内无法恢复至正常水平,这些都引起了政府和社会的广泛关注。本研究以什邡市地震灾区作为调查地,调查震后居民的健康状况,了解心理伤害的程度,以期对受灾居民进行合理有效的震后干预提供参考,为国家地震灾后卫生重建工作提供依据。本研究结果证实灾难性应激事件对居民的心理健康状况产生了重大影响。调查结果显示地震后社区居民的一般生命体征均发生了不同程度的变化,还证实震后灾区居民出现了明显的焦虑、抑郁状态和多种神经系统症状。因此,在给予紧急物质救援的同时,加强对自然灾害的防患意识和灾难意识、启动灾难相关知识的培训与教育、建立快捷的紧急救治机制和群体心理评估及干预机制十分必要,值得政府有关部门和广大卫生工作者关注。更多还原

【Abstract】 With social economy progress,people living standard enhancement and health service development,the health status enhances unceasingly in recent years.The health status is related with the healthy consciousness,the diet structure,the life style,the income level and the medical condition,besides congenital factor.In our research,the health status of acute cerebral infarction patients in convalescence stage and the psych-health status of habitants in Wenchuan earthquake disaster were studied to promote rational use of health resources and provide the foundation of evidence-based medicine.1.Stroke is the most common disease,which is badly endangering human life and health now.It brings heavy economic and mental burden to patient and the society.Therefore,the health status of acute cerebral infarction patient was evaluated by Stroke-Specific Quality of Life Scale(SS-QOLS) and the National Institutes of Health Stroke Scale(NIHSS) in order to improve the patient prognosis,the quality of life and instruct the clinical treatment.QOL of acute cerebral infarction patient decline generally,especially in work ability and social activity,which reflects that the patient with acute cerebral infarction are sick after living space narrowing,loss of society’s workforce,there is a certain mental stress,and bring the more disease burden for family and society.Therapy in hospital at different grades has no different effect on QOL,which prompt the patient should choose the second or more than second grade hospital in nearby cities.Moreover,the patient should receive treatments as soon as possible.Patient with different lesion region has no different nerve function improvement,but clinician can control the medical and inspect expense,and try best to reduce the payment of acute cerebral infarction patient.Neural function recovery of patient after different treatments has no different,which remind clinician to be cautious using expensive medicine and unnecessary therapy,which can reduce the medical cost and lessen economic burden of patient.These studies provide scientific and reasonable suggestions to both patient and clinician,and it also provide dependable evidences of evidence-based medicine for policy development of government and the relevant departments.On the one hand,the patient should be taken to the nearest medical institution.It is useless to choose the major general hospital for the QOL of acute cerebral infarction patient.On the other hand,the clinician should formulate clinical treatment plan,according to the developed requirements of pathogenetic condition,choose low-cost treatments plan and degrade economic burden.At the same time,it is clinician’s responsibility to pay attention to the psychological,emotional and spiritual guidance of the patient,and reduce the stress of spirit during treatment simultaneously,which is important for patient to recover and integrate into family and society early.2.The Wenchuan earthquake caused not only the heavy loss of life and property,but also a serious impact of the living and health conditions, especially the psychological state of victims cannot restore to normal levels in a short period,which caused widespread concern.In this study,survey area is Shifang,the earthquake-stricken city.We investigated the health status of habitants after the earthquake and understand the extent of psychological damage,in order to provide the reference for the basis treatment after the earthquake and the foundation for the national post-earthquake reconstruction work.These findings confirm the Wenchuan earthquake,as a disastrous stress event,impact on the health status of habitants.Habitants had different changes after the earthquake.There is evident anxiety,depression and psychiatric symptoms.As a result,combined with providing emergency material aid,it is necessary to enhance the awareness of natural disasters and disaster prevention awareness,train and educate disaster-related knowledge,establish the efficient mechanisms for emergency medical treatment and psychological assessment,which should be paid close attention by the government department and the general health workers.更多还原