基于慢性病轨迹模式的缺血性脑卒中病人健康管理方案的构建  

Construction of a health management program for ischemic stroke patients based on chronic disease trajectory model

作　　者：陈伟 蔡久梅 卢大荣 盛洁欣 詹晓庆 尹春梅 吴丽 CHEN Wei;CAI Jiumei;LU Darong;SHENG Jiexin;ZHAN Xiaoqing;YIN Chunmei;WU Li(The Affiliated Hospital of Zunyi Medical University,Guizhou 563000 China)

机构地区：[1]遵义医科大学附属医院,贵州563000 [2]贵州医科大学附属医院

出　　处：《护理研究》2024年第19期3442-3449,共8页Chinese Nursing Research

基　　金：2024年度贵州省卫生健康委科学技术基金项目,编号:gzwki2024‐264;遵义市科技计划项目,编号:遵市科合HZ字〔2023〕335号。

摘　　要：目的:构建基于慢性病轨迹模式的缺血性脑卒中病人健康管理方案,为缺血性脑卒中病人的健康教育工作提供参考依据。方法:2022年9月—12月,以慢性病轨迹模式为理论基础,系统检索国内外文献,提取证据并进行归纳整合,结合临床实践经验和病人的实际需求构建健康教育方案的初稿,通过专家小组会议对方案初稿进行修订完善。结果:最终形成的脑卒中住院病人健康管理方案包括4个一级指标、19个二级指标、70个三级指标,主要涉及急性期的健康教育、稳定期的健康教育、出院前期的健康教育和康复期的健康教育4个方面。结论:基于慢性病轨迹模式构建的脑卒中住院病人健康教育方案具有一定的科学性和可行性,可指导临床护理人员为病人提供全面、专业、个体化、规范的健康教育工作,进而提高脑卒中住院病人生活质量并降低复发风险。Objective:To construct a health management program for ischemic stroke patients based on chronic disease trajectory model,and to provide references for the development of health education for ischemic stroke patients.Methods:From September to December 2022,based on the trajectory model of chronic diseases,domestic and foreign literature are systematically searched,evidence extracted and summarized,and the first draft of the health education program is constructed based on clinical practice experience and actual needs of patients.The first draft of the program will be revised and improved through expert group meetings.Results:The final health management plan for inpatients with stroke included 4 first-level indicators,19 second-level indicators and 70 third-level indicators,mainly in four aspects:health education in the acute period,health education in the stable period,health education in the pre-discharge period and health education in the rehabilitation period.Conclusion:The established health education program of ischemic stroke patients is highly scientific and feasible,which can provide guide clinical nurses to provide comprehensive,professional,individualized and standardized health education for patients,thereby improving the quality of life of stroke inpatients and reducing the risk of recurrence.

关 键 词：脑卒中 慢性病轨迹模式 健康教育 循证护理 方案构建 

分 类 号：R473.74[医药卫生—护理学]