目的 基于临床实践,探讨结合微信平台的综合干预对卒中后非痴呆认知障碍(PSCIND)患者的干预效果.方法 对2018年6月至9月海南医学院第二附属医院神经内科收治的脑卒中患者进行认知功能评估,对符合纳入标准的65例患者按编号通过数字随机表法分为两组,对照组33例,试验组32例.对照组给予常规药物治疗,试验组在给予药物治疗的基础上利用微信管理平台对患者进行健康教育、认知训练、远程家庭康复指导及心理疏导,定期对受试者进行随访,并督促受试者按时完成干预内容.连续干预6个月,干预前、干预后3个月及干预后6个月,分别运用简明心理状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)进行认知评估.结果 重复测量方差分析显示,试验组与对照组在基线、干预后3个月、干预后6个月的注意力、语言、延迟回忆、MMSE总分及MoCA总分存在明显的时间因素与组别因素的交互作用(P＜0.01),表明两组研究对象的注意力、语言、延迟回忆、MMSE总分和MoCA总分随时间变化均有改善,且试验组优于对照组.结论 结合微信平台进行健康宣教、认知训练、定期监督与指导的综合干预可以促进脑卒中后认知功能损害的恢复,更有助于PSCIND患者的康复.

卒中后引起的认知功能损害严重阻碍了患者再次回归社会及工作岗位的可能,同时降低了患者的生活质量.对PSCI患者进行早期干预与研究成为了当前的热点,本文就近年来国内外研究成果对卒中后认知功能障碍(post-stroke cognitive impairment,PSCI)的药物治疗以及非药物干预进行综述.

Objective Based on Chinese guidelines for the management of ischemic stroke, a standardized stroke management program was performed to provide intensive education and training for medical physicians, aiming to enhance their knowledge and ability for ischemic stroke prevention and treatment, thereby reducing patients′ in-hospital cost and length of stay, and improving patients′ clinical prognosis. Methods This study was conducted in 20 general hospitals throughout Hainan province. A total of 163 physicians from 20 hospitals involved in the management of stroke patients were trained by highly experienced physicians based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014 and the Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Prior to and post the standardized stroke management training, the data of 3218 and 3367 patients with ischemic stroke were respectively collected. Quality of life assessments including the Barthel index (BI) and the modified Rankin Scale (mRS) score of all patients were recorded at baseline and after discharge. The length of stay and in-hospital cost were directly collected from the hospital information system. Results Physicians′ knowledge and ability manifested as testing scores were significantly improved after training (78.2 ± 15.5 vs 55.6 ± 10.7, t=69.1, P<0.01). The average length of stay of post-training patients was significantly shorter than that of pre-training patients ((8.7 ± 0.9) vs (11.7 ± 1.5) days, t=97.9, P<0.01). The average in-hospital cost of post-training patients was significantly less than that of pre-training patients ((7681.7 ± 1397.7) vs (11846.2 ± 2514.6) Yuan, t=82.5, P<0.01). Both BI (68.2 ± 3.2 vs 43.5 ± 5.3, t=227.7, P<0.01) and mRS score (2.74±0.51 vs 3.65±0.71, t=59.5, P<0.01) were significantly improved for post-training patients. Multivariate linear regression analysis illustrated that standardized stroke management was negatively associated with in-hospital cost (r=-0.461, P<0.01), length of stay (r=-0.357, P<0.01) and mRS score (r=-0.298, P<0.01), and was positively associated with levels of BI (r=0.376, P<0.01). Conclusion Standardized stroke management program might be a cost-effective choice for the management of ischemic stroke as it reduces the in-hospital cost and improves patients′BI and mRS levels.

Population Health ManagementVol. 21, No. 3 Letter to the EditorCost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, ChinaZhongqin Wan, Chaoyun Li, Faqing Long, Yuhui Zhang, Bufei Wang, Yingman Wu, Mingming Dai, Desheng Wang, Bin Chen, Yangyang Duan, and Qingjie SuZhongqin WanSearch for more papers by this author, Chaoyun LiSearch for more papers by this author, Faqing LongSearch for more papers by this author, Yuhui ZhangSearch for more papers by this author, Bufei WangSearch for more papers by this author, Yingman WuSearch for more papers by this author, Mingming DaiSearch for more papers by this author, Desheng WangSearch for more papers by this author, Bin ChenSearch for more papers by this author, Yangyang DuanSearch for more papers by this author, and Qingjie SuSearch for more papers by this authorPublished Online:1 Jun 2018https://doi.org/10.1089/pop.2017.0205AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Cost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, China." Population Health Management, 21(3), pp. 253–254FiguresReferencesRelatedDetailsCited byReview of cost-effectiveness of antithrombotic alternatives in patients with atrial fibrillation1 July 2021 | Revista da Associação Médica Brasileira, Vol. 67, No. 7 Volume 21Issue 3Jun 2018 InformationCopyright 2018, Mary Ann Liebert, Inc.To cite this article:Zhongqin Wan, Chaoyun Li, Faqing Long, Yuhui Zhang, Bufei Wang, Yingman Wu, Mingming Dai, Desheng Wang, Bin Chen, Yangyang Duan, and Qingjie Su.Cost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, China.Population Health Management.Jun 2018.253-254.http://doi.org/10.1089/pop.2017.0205Published in Volume: 21 Issue 3: June 1, 2018Online Ahead of Print:March 12, 2018PDF download

Objective To explore the effect of mobile phone-based health education on independent living ability of postoperative patients with hypertensive intracerebral hemorrhage. Methods Sixty patients with postoperative hypertensive intracerebral hemorrhage who underwent craniotomy in our hospital during March 2016 and December 2017 were divided into experimental and control groups, 30 cases in each group, according to the random number table method. Functional training conducted during hospitalization in both groups. After discharge, the control group used a telephone for follow-ups every 2 weeks and took part in a face-to-face training in the first month to implement continuous nursing intervention for a total of 3 months. After discharge, in the experimental group, various information forms of rehabilitation training for hypertensive intracerebral hemorrhage were comprehensively integrated, and mobile phone education was used for a total of 3 months in addition to the training as in the control group. The two groups were compared in terms of independent living ability between the two groups. Result The scores of independent living ability and self-care ability, action ability, metastatic ability, social cognitive ability and communication ability of the experimental group were significantly higher than those of the control group (P＜0.05). Conclusion The mobile phone-based education can promote the effect of rehabilitation exercise in patients with hypertensive intracerebral hemorrhage, so as to promote the independent living ability of patients.