【作者】 孙悦；

【导师】 资晓宏；

【作者基本信息】 中南大学 ， 神经内科， 2008， 硕士

【摘要】 研究背景:随着我国进入老龄化社会,脑卒中的发病率也逐年上升,而且有年轻化的趋势。近年来由于诊疗水平的提高,脑卒中的死亡率已大为降低,但是其致残率仍高达80%。早期,由于综合性治疗的及时介入促进患者在住院期间的功能恢复。但是,当脑卒中患者回归家庭和社区时,通常还是遗留各种后遗症,如运动、认知、语言功能的障碍及就业能力障碍等,这些功能障碍从不同程度上影响了患者的生活质量,同时给患者、家庭和社会造成了沉重的负担。国内外最近几年的研究显示,社会因素在预防疾病发展中起重要作用,社会支持与疾病康复效果存在一定的关系。目前,在对脑卒中预后影响因素的研究中,涉及社会支持方面的不多,且较浅显。因此,本研究将从多方面进行社会支持对脑卒中患者预后影响的研究,有助于找寻提高患者生存质量的有效途径。目的:对急起脑卒中患者进行社会支持方面的调查,同时观察患者起病时、起病3个月后,这两个不同阶段患者的神经功能水平、日常生活能力及生活质量的情况,并进行横向及纵向的对比,分析社会支持与脑卒中患者预后二者之间的相互关系,以期为改善社会支持、更好地提高患者的生存质量,降低脑卒中的致残率与死亡率,减轻社会和家庭的负担提供参考依据。方法:本研究为预后研究,采用问卷调查的形式收集资料,选取2007年1月1日至2007年11月30日期间起病的、选择在中南大学湘雅三医院就医的脑卒中患者,根据研究制定的入选研究标准,将符合研究标准的患者共189人纳入研究。评估量表采用社会支持量表、中国卒中量表、改良巴氏指数量表、脑卒中患者生活质量量表,评估时间分别为:初发病时、病后第三个月末分别进行评估。资料分析采用t检验、直线相关分析等方法进行统计学分析,比较社会支持对于脑卒中患者神经功能、日常生活能力等方面的康复及卒中后生活质量的影响。结果:社会支持对入院时临床神经功能缺损程度为轻型的脑卒中患者康复无影响(P＞0.05),而对临床神经功能缺损程度为中、重型的脑卒中患者康复有影响(P＜0.01),并呈显著性正相关。社会支持对入院时日常生活能力基本自理的脑卒中患者康复无影响(P＞0.05),对日常生活能力部分依赖及完全依赖的脑卒中患者康复有影响(P＜0.01),并呈显著性正相关。脑卒中患者卒中后生活质量与社会支持总分及客观支持、主观支持、支持利用度等3个维度评分均呈显著性正相关。结论:1、社会支持对脑卒中患者神经功能恢复、日常生活能力改善、卒中后生活质量有积极影响。2、病情严重程度可能是影响脑卒中患者社会支持程度的因素之一。3、提高脑卒中患者的社会支持利用度可能对改善预后有帮助。更多还原

【Abstract】 Background: Along with our country stepping into the the aging society, the incidence rate of stroke rises year by year. Because of the advancement in diagnosis and therapy, the mortality rate of stroke has declined in recent year, however, the deformity rate has reached to eighty percent. In the early course of the disease, complete rehabilitation therapy interventions can provide the possibility of patient’s function recovery in charge. But when the patients go back to family and society, there are usually functional disability left, including the dysfunctions in movement, recognition, speech and occupation, which lower the patients’ quality of life and load heavy burdens on the family and society as well.Recent researches reveal that social factors plays an important role on preventing the progression of disease, and there is some relationship between social support and rehabilitation of disease. So far,the studies about influencing factors of the prognosis of stroke have been related to social support rarely. Therefore, making a detailed research on social-support’impact on the prognosis of stroke patients is very helpful to finding effective ways of improving the quality of life.Objective:To provide a good reference about how to improve the quality of stroke patients’life, lower the mortality rate and the deformity rate of stroke, reduce the burden of society and family by improving social support through the actual following research process. First, investigating the situation of the acute stroke patients’social-support, then observing their physical functional levels, activities of daily living and quality of life both at the entrance and the end of the third month. Second, doing horizontal and vertical comparison among the selected factors. Finally,coming to the conclusion that there is some relationship between social support and the prognosis of stroke patients.Methods:It is a research about prognosis, and all the data was collected by survey. According to the established entrance standards, we recruited 189 patients from the population who hospitalized in the Third Xiang Ya Hospital of Central South University after stroke in the period from January 1, 2007 to November 30, 2007. We selected the Social Support Rating Scale, China Stroke Scale, Modified Barthel Index and the Quality of Life of Stroke Patients Scale to evaluate the activities of daily living, nerve functional levels and quality of life at the entrance and the end of the third month.Data analysis:we used the t-test and linear correlation as methods of statistical analysis to compare the activities of daily living, nerve functional levels and quality of life and reveal the effects of social support.Results:Social support had no effects on rehabilitation of light clinical neural functional default of patients with stroke(P>0.05), but it had effects on rehabilitation of moderate and severe clinical neural functional default of patients with stroke(P<0.01). Moreover, they are positively correlated.Social support had no effects on rehabilitation of light activities of daily living default of patients with stroke(P>0.05), but it had effects on rehabilitation of moderate and severe activities of daily living default of patients with stroke(P<0.01). Moreover, they are positively correlated.The quality of life of stroke patients correlate with social support including objective support, subjective support and utilization of support positively.Conclusion:1.Social support have a positive effect on recovery of nerve functional levels and activities of daily living, and quality of life after stroke.2.The severity of diseases may be one of the influencing factors of social support.3. Improving utilization of support of patients with stroke may be helpful for the prognosis of stroke.更多还原