上海市闸北区残疾人辅助器具组合适配项目效果评价研究采用“政策制定科学程序”和“结构—过程—结果”原理，综合运用定性定量的方法，评价闸北区残疾人辅助器具组合适配的资源配置情况、实施过程及实施效果，分析影响辅助器具组合适配效果的因素，并探讨相应的解决措施。

目的 对经皮穿刺内镜下胃造瘘术(PEG)和鼻饲胃管(NGT)两种不同胃肠营养方式下吞咽康复训练疗效进行成本效果分析研究.方法 采用前瞻性对照研究方法,将接受PEG胃肠营养者设为PEG组,入组一例PEG组后,同时随机配对入选一例接受NGT胃肠营养者设为NGT组,每组分别入选10例患者.2组患者均给予为期12周的吞咽康复训练治疗.分别于入选时及入选后8周和12周时,采用洼田饮水试验评分标准评定2组患者的临床吞咽功能,并记录患者体重、体重指数、吸入性肺炎和鼻饲胃管更换次数以及并发症发生情况等相关指标;分别采集2组患者在12周治疗期间的直接医疗费用(包括住院相关费用、西药费和中药费以及康复治疗费用和PEG置管或NGT更管的相关费用),并对所有数据进行统计学分析比较.结果 (1)经为期12周的吞咽康复训练治疗后,2组患者洼田饮水试验评分均逐渐降低,PEG组较NGT组降低更为明显(P＜0.01);入选后12周时,2组患者的体重差异不明显(P＞0.05),但2组患者治疗12周后的体重指数分别为(21.04±0.93) kg/m2和(19.85 ±0.93) kg/m2,组间差异有统计学意义(P＜0.05);随访期间,2组患者吸入性肺炎发生次数比较,差异有统计学意义(P＜0.05).入选后8周和12周时,PEG组患者洼田饮水试验评分的改善值[(1.9±0.6)和(2.6±0.7)分]与NGT组的改善值[(0.9±0.3)和(1.6±0.5)分]比较,PEG组明显优于NGT组(P＜0.01);随访12周后,2组患者的体重指数改善值[(0.72±0.33) kg/m2和(0.12 ±0.23) kg/m2]组间比较,差异有明显统计学意义(P＜0.01).(2)在12周康复治疗期间,2组患者的常规住院费、西药费、中药费、康复治疗费、PEG置管或NGT相关费用和总费用等组间比较,差异无统计学意义(P＞0.05);但PEG组的PEG置管费(2656.00元)和NGT组的胃管更置费(1131.90元)比较,组间差异有统计学意义(P＜0.01).PEG组随访期间并发肺炎的平均治疗费为(652.75±923.13)元,而NGT组为(2014.20±1061.58)元,PEG组明显低于NGT组(P＜0.01).PEG组其它并发症平均处理费有850.25元,因此PEG组总的并发症处置费(1503.00元),仍低于NGT组并发症处置费(2014.20元),但差异无统计学意义(P＞0.05).结论 PEG胃肠营养方式下的吞咽康复训练是一种经济有效的康复训练模式,值得在社区吞咽康复中推广和应用.

Objective: To summarize the experience of the swallowing rehabilitation nursing of ten cases after percutaneous endoscopic gastrostomy in the community. Methods:A prospective study was conducted which accepted ten patients with moderate and severe central swallowing disorder who had percutaneous endoscopic gastrostomy (PEG) and were given standardized rehabilitation nursing and swallowing rehabilitation training. At the same time, the rehabilitation nursing staff should be trained on the standardized rehabilitation nursing knowledge which the PEG catheter is placed postoperatively and the nursing skills which deal with the appearance of other abnormalities. Results:The scores of the enrolled patients in 2, 4, 8 and 12 weeks evaluated with Kubota’s drinking water test were:5.0, 4.7, 3.9, 3.1 and 2.4, respectively, and their body mass index 20.32, 20.29, 20.45, 20.74 and 21.04, respectively. Their scores of improvement value in 2, 4, 8, and 12 weeks evaluated with Kubota’s drinking water test were 0.3, 1.1, 1.9 and 2.6, respectively. After 12 weeks their body weight and body mass index were improved 2.1 kg and 0.72. Among of ten patients, only one successfully removed the PEG catheter, five person times occurred pulmonary infections, one had mild PEG fistula catheter orifice infection, one suffered from gastrorrhagia PEG postoperative, two had PEG fistula built-in mushroom head off in the duodenal intestine that blocked intestine, and one got fistula external rubber tube rupture. Conclusion:The standardized rehabilitation nursing is benefit for the patients’ swallowing rehabilitation training and improves their quality of life.

目的:探索不同胃肠营养方式下吞咽康复训练改善患者吞咽功能的影响.方法:采用前瞻性对照研究方法.接受经皮穿刺内镜下胃造瘘术(PEG)者设为PEG训练组,入组l例PEG训练组后,同时随机配对入选1例接受鼻饲胃管者,设为鼻饲胃管(NGT)训练组.两组患者均给予相同的吞咽康复训练,分别于入选时,训练后2周、4周、8周和12周采用洼田饮水试验评分标准进行评测,同时记录两组患者身高、体重、血红蛋白、白蛋白、吸入性肺炎和鼻饲胃管更换次数等相关指标.结果:20例患者入选,每组各10例,无失访病例.入选时,2周、4周、8周和12周时PEG训练组患者的洼田评分均分分别是:5.0分、4.7分、3.9分、3.1分和2.4分,2周后、4周后、8周后和12周后PEG训练组洼田评分的改善值均分分别是:0.3分、1.1分、1.9分和2.6分；而NGT训练组评分均分分别为:4.9分、4.9分、4.2分、4.0分和3.3分,改善值均分分别是:0分、0.7分、0.9分和1.6分.入选时,2周、4周、8周和12周时PEG训练组患者的体重指数别是:20.32、20.29、20.45、20.74和21.04,而NGT训练组分别为:19.73、19.70、19.80、19.94和19.85.入选后12周PEG训练组体重和体重指数分别改善2.1kg和0.72,NGT训练组分别改善0.4kg和0.12.血红蛋白和白蛋白随访期间两组间变化无显著性意义.PEG训练组发生5人次吸入性肺部感染,NGT训练组有12人次吸入性肺部感染,最少更换3次胃管,最多更换8次胃管,平均更换(4.9±1.7)次胃管.结论:经皮穿刺内镜下胃造瘘术联合吞咽康复训练可以明显改善社区中脑损伤后吞咽功能障碍患者的吞咽功能.

Objective To evaluate the internal reliability of Psychosocial Function Evaluation for mental disabled people in day care unit. Methods 16 participants were evaluated twice by the same rater (social worker) in the unit at the Permanent stage and the Steering stage. Results Cronbach's α was greater than 0.7 in the both evaluation. The Spearman correlation coefficient between each dimension and total score were between 0.502 and 0.869. Conclusion The internal reliability of Psychosocial Function Evaluation is satisfactory for mental disabilities.

目的 探索不同胃肠营养方式下吞咽康复训练对中度和重度吞咽功能障碍患者的治疗作用和效果.方法 采用随机对照试验研究的方法,将本院收治的中度和重度吞咽功能障碍患者中,接受经皮穿刺内镜下胃造瘘术(PEG)进行胃肠营养方式者设为PEG训练组(PEG组),同时随机配对接受鼻饲胃管(NGT)营养方式者设为NGT训练组(NGT组).共纳入患者20例,每组10例,无1例失访.2组患者均给予相同的吞咽康复训练,分别于人选时及康复训练后2、4、8和12周,采用生活质量测定量表简表和洼田氏饮水试验评分标准进行生活质量和临床吞咽功能的评测,同时记录2组患者体重指数、吸人性肺炎发生次数和鼻饲胃管更换次数,以及2组患者并发症情况等相关指标.结果 生活质量量表中的心理状态项目评分在吞咽康复训练后2周,生理健康、与周围环境的关系和综合自评分等项目评分在吞咽康复训练后4周,社会关系、自身生活质量总主观感觉和自身健康状况总主观感受等项目评分在吞咽康复训练后8周,2组间比较,差异有统计学意义(P＜0.05)；PEG组生活质量相应项目评分明显高于NGT组的评分(P＜0.05).在康复训练后8周和康复训练后12周时,2组患者的洼田氏饮水试验评分组间比较,差异有统计学意义(P＜0.01),吞咽康复训练后4周,PEG组洼田氏饮水试验评分的改善值与NGT组比较,差异有统计学意义(P＜0.01)；在吞咽康复训练后12周时,2组患者体重指数组间比较,差异有统计学意义(P＜0.01).在整个随访治疗期间,PEG组仅有1例患者吞咽功能改善后成功拔除PEG置管,但发生5人次吸人性肺炎；NGT组无1例患者成功拔除鼻饲胃管,有12人次吸人性肺炎,NGT组鼻饲胃管最少更换3次胃管,最多8次胃管,平均每例患者更换(4.9±1.7)次胃管.随访期间2组发生吸人性肺炎人次数比较,NGT组明显多于PEG组,且差异有统计学意义(P＜0.05).结论 PEG联合吞咽康复训练是一种有效干预中度和重度吞咽功能障碍患者的方法,可以明显改善患者的生活质量和吞咽功能.

Objective To investigate the quality of life and analyze related factors of all the disabled at the entry of the Home Service Program in Zhabei district,Shanghai.Methods All the disabled were surveyed using the Chinese version of Short-Form 36 Health Survey(SF-36).Results 280 disabled people finished the survey,the total score was(59.72±20.03).There were significant differences in the scores among different ages,types of disabilities and status of subsistence allowances(P0.01).The age was negatively correlated with quality of life(P0.01).The education degree and the status of subsistence allowances were positively correlated with quality of life(P0.05,P0.01).Conclusion People with disability have poor quality of life in Zhabei district,Shanghai.

吞咽功能障碍常见于中枢神经系统疾病患者中,脑血管病和颅脑外伤极易引起吞咽功能障碍,文献报道40％～73％的脑血管病患者会发生不同程度的吞咽障碍[1-2],Lawrence等[3]统计1259例多种族的急性脑血管病患者,吞咽障碍发生率为44.7％.

Objective To explore new effective ways of rehabilitation therapy suitable for community older children with cerebral palsy.Methods Thirty-one children with cerebral palsy over 7 years old from 9 communities in Zhabei District of Shanghai,they were randomly divided into the vacation rehabilitation group and the routine rehabilitation group.The vacation rehabilitation group were treated with intensive rehabilitation during the holidays while the routine rehabilitation group were given the conventional rehabilitation guidance.Both the two groups were evaluated by Functional Comprehensive Assessment(FCA) before treatment,6 and 15 months after treatment respectively.Results Fifteen months later,the comprehensive scores in both groups were improved,but the score difference before and after treatment had statistically significant between the two groups(P<0.05).ConclusionHoliday intensive rehabilitation treatment can effectively improve the comprehensive function of older children with cerebral palsy.

社区康复是在社区和家庭层面上.为残疾人提供的康复服务.其覆盖面广、经济有效、简便易行,有利于调动社区、家庭的力量和患者的积极性,能够使残疾人回归家庭和社会,使大多数的残疾人从中受益.

Objective To investigate the factors influencing basic rehabilitation service needs of people with disability at Zhabei District in Shanghai.MethodsPrimary rehabilitation demands and services of 10 311 disabled persons in Zhabei District were surveyed.ResultsThe screening rate of persons with disability having primary rehabilitation demands was 83.5%.And the gender,age,type of disability,disability level,education,employment might be the factors affecting the primary rehabilitation demands of people with disability.ConclusionThe primary rehabilitation service demands vary in deferent types of people with disability.The various services based on the extensive rehabilitation services should be provided to deferent categories of people with disability.

Objective To provide the advice on how to optimize the allocation of resources and make other policy through the analysis factors affecting rehabilitation services needs of people with disability at Zhabei district in Shanghai.MethodsThe factors affecting rehabilitation services needs such as types of disability,disability levels,education,employment,marital status,age and sex were analyzed with Logistic analysis.ResultsThe factors affecting primary rehabilitation services were types of disability,education,employment situation,marital status and sex.And people with disability had the characters of female,hearing disability,retired returned to more primary rehabilitation services,with OR values being 1.219,1.544 and 1.533 respectively compared with itself controls.And the high educational disable people' will,returning to primary rehabilitation services,was weaker compared with low educational disable people.The factors affecting special rehabilitation services were types of disability and employment situation.And people with disability had the characters of hearing disability,unemployment returned to more special rehabilitation services,with OR values being 2.380 and 1.310 respectively compared with itself controls.ConclusionThe rehabilitation needs are different among different groups people with disability,so the factors affecting rehabilitation services needs such as types of disability,education,employment situation,marital status and sex should be taken into consideration while activating primary rehabilitation services,while the types of disability and employment situation should be taken into more consideration while activating special rehabilitation services.

Objective; To evaluate the expense of community-based tertiary rehabilitation in stroke patients through the cost -effect analysis. Method: Forty -nine subjects were randomly divided into two groups according to their community: the rehabilitation group was administered community-based tertiary rehabilitation in addition to routine interventions of internal medicine; the control group was only given the routine ones without standard community-based rehabilitation. All the patients were assessed with clinical neural impairment measure scale (NIM) at the enrolling time, the end of the 2nd month and the 5th month. At the same time, the cost was investigated. Result: There were no significant difference between the two groups in NIM scores at the entering point. However, 2 months and 5 months later, NIM scores decreased 3.26 and 4.74 in the rehabilitation group respertively, while 1.08 and 1.84 in the control group respectively, both differences were significant between the two groups (P0.01).At the end of the 2nd month and the 5th month decreased one point of NIM score. The total costs, direct medical costs, total rehabilitation costs and medicine costs of the rehabilitation group were $752.82,$447.75 ,$199.89,$241.99 and $1176.76,$647.01,$255.52,$382.22 respectively, while the costs of the control group were $2760.36, $1443.69, $358.30,$1072.06 and $3899.72, $1988.45, $503.91 and $1475.41.Conclusion: Community -based tertiary rehabilitation is an economical and effective medical strategy for stroke patients in community.

Objective:To investigate the effects of community -based tertiary rehabilitation on improving neural function of stroke patients. Method:Forty -nine patients were enrolled, and randomly divided into two groups according to their community. Those in rehabilitation group were administered community -based tertiary rehabilitation in addition to routine interventions of internal medicine,while those in control group were only given the routine ones,without standard community-based rehabilitation. All the patients were assessed with clinical neural impairment measure scale (NIM) at the enrolling time and the end of 2 months. Result:There was no significant difference between the two groups in NIM scores at the enrolling time. However, 2 months later, NIM scores decreased by 3.26 in rehabilitation group,while 1.08 in control group, the differences were significant between the two groups (P 0.01). Conclusion: Community -based tertiary rehabilitation could significantly improve the neural function of stroke patients.