目的 调查门诊脑卒中患者残疾接受度和功能锻炼依从性水平,并探讨二者之间的相关性.方法 采用脑卒中患者残疾接受度量表和功能锻炼依从性量表对196例门诊脑卒中患者进行问卷调查.结果 门诊脑卒中患者残疾接受度得分为(76.18±14.11)分,患者的功能锻炼依从性得分为(33.74±9.26)分.患者残疾接受度和功能锻炼依从性呈正相关(r=0.401,P＜0.001).结论 门诊脑卒中患者的残疾接受度和功能锻炼依从性有待提高,残疾接受度较高者的功能锻炼依从性较好.医护人员应提高门诊脑卒中患者残疾接受度,加强其功能锻炼效果自我评估和自我学习,从而促进患者康复.

目的 编制脑卒中患者预防跌倒行为评价量表,并检测其信度和效度.方法 以健康信念模式及健康行为自我管理理论为依据,系统归纳现有的预防跌倒行为评估工具拟定量表条目池,通过专家咨询、小样本预试验形成量表初稿.采用量表初稿对234例门诊脑卒中患者进行问卷调查,通过条目分析和信度、效度分析进行量表评价.结果 脑卒中患者预防跌倒行为量表共包括23个条目,探索性因子分析产生5个公因子,累积方差贡献率为56.356％,分别为生活方式管理、环境安全维持、行为安全控制、资源利用和卒中症状应对5个维度.量表条目内容效度(I-CVI)平均值为0.826,平均一致性(S-CVI/Ave)为0.948.总量表Cronbach'sα 系数为0.855,其中各维度的信度为0.701～0.821.结论 本研究所编制的脑卒中患者预防跌倒行为量表具有良好的信度和效度,适用于测评脑卒中患者的预防跌倒行为,具有应用价值.

Objective To explore the prevalence of diabetes and hyperlipidemia in cerebral infraction patients with hypertension and look into the rates of awareness, treatment and control. Methods Blood pressure, blood glucose and blood lipids were measured in 238 cerebral infraction patients with hypertension. Meanwhile, the rate of awareness, treatment and control of hypertension, diabetes and hyperlipidemia were investigated by questionnaire. Results Among 79.41％of the patients had abnormal blood pressure and cerebral infaction on admission, the rates of awareness , treatment and control of hypertension were 74.79％, 67.23％, 20.59％. 10.11％of them never took antihypertensive drugs in spite of their awareness of hypertension. 32.35％ of the patients were combined with diabetes, the rates of awareness, treatment and control were 79.22％, 62.34％, 12.99％respectively, and among them 21.31％never tookantidiabetic drugs in spite of awareness of diabetes. 81.51％ of the patients were combined with hyperlipidemia, the rates of awareness, treatment and control were 23.20％, 6.70％, 1.55％respectively, and among them 71.11％never took lipid-lowering drugs with awareness of high blood lipid. Conclusions 79.41％ of the incidence of cerebral infraction was related to abnormal blood pressure. 32.35％cerebral infarction patients with hyperlipdemioa are complicated with hypertension diabetes;81.51％are complicated with 28.57％cerebral infraction patients with hypertension were complicated with diabetes and hyperlipidemia as well, but the rate of awareness, treatment and control were relatively low. In order to improve the secondary prevention, we should pay more attention to the stroke risk factors, and help make the individualized medicine-taking plan to improve the control rate.

目的 探讨老年高血压伴脑梗死患者的健康行为及其影响因素.方法 采用健康促进生活方式量表(HPLPⅡ)对广州两所三甲医院的老年高血压伴脑梗死患者223例进行调查.结果 老年高血压伴脑梗死患者的HPLPⅡ均分为(2.43±0.35)分,运动锻炼及先兆观察维度得分最低.Barthel指数、脑卒中病程、文化程度进入了回归方程.结论 老年高血压伴脑梗死患者的健康行为不容乐观,存在功能缺陷、脑卒中病程短、文化程度低的患者的健康行为尤应引起关注;建议加强延续护理、争取老年患者亲属的支持、及早并坚持康复运动,优化老年健康教育策略,以提高老年高血压伴脑梗死患者的健康行为.

Objective To develop a comprehensive reminder system based on health belief model (CRS-HBM) and evaluate its effect on healthy behaviors among discharged ischemic stroke patients.Methods We enrolled a convenience sample of 87 hypertensive ischemic stroke inpatients who received treatment in Guangdong Provincial Hospital of Chinese Medicine,The Third Affiliated Hospital,Sun Yat-Sen University and Second Affiliated Hospital of Sun Yat-Sen University from February 2015 to March 2016.The CRS-HBM was developed and applied to a program conducted in these patients consisting of face-to-face health belief-related education before discharge and a 6-month intervention after discharge including telephone-based education,weekly automated text message-based education,health education through written materials [Handbook of Health Beliefs for Stroke Patients & Monthly Calendar and Journal (hereinafter referred to as the Handbook) and guidance for self-management of the monthly calendar and journal covered in the Handbook].Seventy-six (87.4％) patients completed the whole 6-month intervention and they were surveyed by a self-designed questionnaire covering the implementation status of CRS -HBM and patient satisfaction with the CRS-HBM-based intervention program.The survey achieved a response rate of 100.0％.Ten out of 76 patients were purposively selected for semi-structured interview.The qualitative research method of phenomenology was used to collect,sort,analyze the results of interview and summarize themes.Results The mean time of face -to-face interview before discharge for 76 patients was (29.0 ±5.9) min.The mean time were (6.8 ±3.0),(10.8 ±5.3),(8.9 ±4.3) min for telephone-based education conducted at 1 week,1 month,and 3 months after discharge respectively.All the patients or their relatives received text messages every week during the intervention period,and 22 (28.9％) of them indicated that the text messages were received by their relatives (spouse or children).As for using the self-management sheet included in the Handbook,5 (6.6％) never used,20 (26.3％) used it for less than 1 month,32 (42.1％) used it for l-3 months,11 (14.5％) used it for over 3 months,only 8 (10.5％) used it for the whole 6-month intervention after discharge.As for using the blood pressure record sheet,5 (6.6％) never used it;10 (13.2％) used it for less than 1 month,26 (34.2％) used it for 1-3 months.20 (26.3％) used it for over 3 months,only 15 (19.7％) used it for the whole 6 month after discharge.The scores of patient satisfaction with health belief-related education before discharge,telephone-based education and text message-based education following discharge and the Handbook were (9.88 ± 0.43) (9.59 ± 0.75) (9.81 ±0.39) (9.45 ±0.71) respectively.The 6 themes concluded based on the results of semi-structured interviews are as follows:Health belief-related education could enhance the level of risk awareness of stroke,improve knowledge related to stroke,reinforce the health beliefs and promnote healthy behaviors;The Handbook was comprehensive,practical,illustrated,and convenient for reading;The self-management of the monthly calendar and journal covered in the Handbook could help to modify unhealthy lifestyles;The blood pressure record sheet was concise and convenient to record;Telephone-based education and text message-based education enhanced the intervention effect;The lifestyles were becoming more healthy,but it takes time to correct bad habits.Conclusion Patient satisfaction with the CRS-HBM program is pretty good.The program is scientific,operating,effective and worth popularizing.

Objective To evaluate the effect of goal-setting telephone reminds on medication adherence for patients with ischemic stroke.Methods An assessor-blinded,parallel-group,randomized trial was conducted.91 patients with ischemic stroke were randomly divided into control group and intervention group.Patients in control group was treated with routine health education.Patients in intervention group received the routine health education and 3 times of telephone reminders under the guidance of setting drug goals and action plans by intervention nurse (first weeks after discharge,after the discharge for first months and 3 months).Data for medication adherence were respectively collected and compared at baseline and at the 3rd,6th month after discharge from hospital using the Morisky medication adherence scale (MAS).Results At the 6th month after discharge,patients in the intervention group had significantly positive medication adherence compared with those in the control group (P＜0.05);but no significant difference was found between the two groups at baseline and at the 3rd month after discharge (P＞0.05).Compared with the baseline data,the medication compliance was improved in both groups at the 3rd month after discharge,but the change was relatively stable from the 3rd to 6th month after discharge.The effect of the intervention could be maintained to the 6th month after discharge with an upward trend,while the control group showed a downward trend.Conclusion The goal-setting telephone reminds is an important strategy of stroke transitional care,and leads to the improvement of medication compliance effectively for patients with ischemic stroke.

AIM The aim of this study was to determine whether the Comprehensive Reminder System based on the Health Belief Model improves health belief, health behaviours, medication adherence and blood pressure control as a means of decreasing the rate of stroke recurrence among hypertensive ischaemic stroke. BACKGROUND Hypertensive patients having experienced recent ischaemic strokes are at high risk for stroke recurrence. Several trials attempted to improve secondary stroke prevention via patient education, however, patient outcomes remained poor. Long-term follow-up studies regarding secondary stroke prevention are limited. DESIGN A multi-centre, 12-month, assessor-blinded, parallel-group, randomized controlled longitudinal trial. METHODS Hypertensive patients having experienced an ischaemic stroke are the target population. The intervention consists of health belief education, a calendar handbook, a weekly automated short-message service and four telephone follow-up interviews. Outcomes will be assessed at baseline and at 3, 6 and 12 months following discharge. The primary outcome is blood pressure control. The secondary outcomes include health belief, health behaviours and medication adherence. The clinical endpoint is the rate of stroke recurrence. DISCUSSION Although many efforts to improve secondary stroke prevention have been undertaken, research indicates that improvements remain possible and warranted. This research protocol based on the Health Belief Model will improve our understanding of stroke education and transitional care needed in China and with the world-wide target population.

目的 探讨门诊脑卒中患者的自我护理能力及影响因素.方法 采用随机抽样的方法,用自我护理能力测定量表(ESCA)对100例门诊脑卒中患者的自我护理能力进行问卷调查.结果 门诊脑卒中患者的自我护理能力总分为118.86 ±22.82分,44％的患者达到中等水平,56％的患者达到高等水平,各维度中,自我护理技能得分最低;男/女、丧偶/已婚、居住在农村/城市、存在自理缺陷/完全自理的患者之间自我护理能力差异显著(P＜0.05).结论 门诊脑卒中患者的自我护理能力呈中等偏上水平,其中健康知识水平和自我护理技能维度的水平相对较差;存在自理缺陷、男性、居住在农村、丧偶患者的自我护理能力较低.

Background: Adopting healthy behaviors is critical for secondary stroke prevention, but many patients fail to follow national guidelines regarding diet, exercise, and abstinence from risk factors. Compliance often decreases with time after hospital discharge, yet few studies have examined programs promoting long-term adherence to health behaviors. Goal setting and telephone follow-up have been proven to be effective in other areas of medicine, so this study evaluated the effectiveness of a guideline-based, goal-setting telephone follow-up program for patients with ischemic stroke. Methods: This was a multicenter, assessor-blinded, parallel-group, randomized controlled trial. Ninety-one stroke patients were randomized to either a control group or an intervention group. Intervention consisted of pre-discharge education and 3 goal-setting follow-up sessions conducted by phone. Data were collected at baseline and during the third and sixth months after hospital discharge. Results: Six months after discharge, patients in the intervention group exhibited significantly higher medication adherence than patients in the control group. There were no statistically significant differences in physical activity, nutrition, low-salt diet adherence, blood pressure monitoring, smoking abstinence, unhealthy use of alcohol, and modified Rankin Scale (mRS) scores between the 2 groups. Conclusions: Goal-setting telephone follow-up intervention for ischemic stroke patients is feasible and leads to improved medication adherence. However, the lack of group differences in other health behavior subcategories and in the mRS score indicates a need for more effective intervention strategies to help patients reach guideline-recommended targets.

目的 了解高血压合并脑梗死患者的健康知识情况,为对其进行健康教育提供参考依据.方法 采用脑卒中健康知识问卷对300例高血压合并脑梗死患者进行问卷调查.结果 高血压合并脑梗死患者的脑卒中健康知识总标准分为66.67(44.44,77.78),卒中先兆和卒中处理得分较低,分别为50.00(33.33,66.67)及50.00(0,100)分.小学及以下学历、卒中病程短、无脑卒中家族史的患者脑卒中健康知识得分较低(P＜0.05).生活起居维度、卒中先兆及危险因素知晓率最低.结论 高血压合并脑梗死患者在卒中先兆和卒中处理部分的健康知识不容乐观,预防复发知识掌握度有待提高;卒中病程短、文化程度低、无脑卒中家族史的老年患者的健康知识尤应引起关注;建议对脑梗死识别、处理、控制危险因素、坚持服药等方面上加强延续护理、争取患者亲属的支持、进行个性化健康教育模式,以提高高血压合并脑梗死患者的健康知识水平.

Objective To investigate the nursing strategy in patients with posterior reversible encephalopathy syndrome(PRES).Methods The clinical data of treatment and care measures in 3 cases of PRES were retrospectively reviewed and analyzed.Results The clinical conditions of all 3 cases were improved in 2 weeks after treatment and nursing,and no recurrence or aggravation was seen during the period of follow up.Conclusion PRES is clinically characterized by hypertension,headache,visual disturbance and seizures.Attention should be paid on nursing observation,strengthening symptomatic care and psychological care,and health education can be helpful in promoting rehabilitation of patients.

[目的]总结和探讨神经梅毒病人的护理措施。[方法]回顾分析36例神经梅毒病人的临床特征及治疗方法,总结其治疗和康复过程中的护理措施。[结果]神经梅毒可造成各种神经功能缺损,主要影响病人精神和认知,经药物治疗和积极有效的护理,34例病人好转出院,随访未见复发或加重,2例拒绝治疗自动出院。[结论]重视对病人在神经功能缺损、药物不良反应、健康宣教、个人防护等方面的护理是促进病人康复、防止院内外感染的重要举措。