重症监护室转出脑卒中患者参与运动康复的障碍因素与促进因素分析:一项混合性研究  

Analysis of Barriers and Facilitators to Exercise Rehabilitation in Stroke Patients Transferred from the Intensive Care Unit:a Mixed Study

作　　者：陆娟[1] 陆文婷[2] 李育平[1] 史甜[1] 唐维婕 翟祎帆 LU Juan;LU Wenting;LI Yuping;SHI Tian;TANG Weijie;ZHAI Yifan(Neurointensive Care Unit,Northern Jiangsu People's Hospital,Yangzhou 225002,China;Department of Critical Care Medicine,Northern Jiangsu People's Hospital,Yangzhou 225002,China)

机构地区：[1]江苏省苏北人民医院神经重症监护室,江苏省扬州市225002 [2]江苏省苏北人民医院重症医学科,江苏省扬州市225002

出　　处：《实用心脑肺血管病杂志》2025年第4期92-97,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省科技项目(BK20231536);江苏省苏北人民医院科研项目(SBHL2308)。

摘　　要：目的 通过定量研究与定性研究相结合的混合性研究分析重症监护室(ICU)转出脑卒中患者参与运动康复的障碍因素与促进因素。方法 (1)定量研究:采用便利抽样法选取2022年5月—2024年5月从江苏省苏北人民医院ICU转出的250例脑卒中患者为调查对象。采用一般资料调查表、中文版脑卒中后身体活动障碍量表(BAPAS)、一般自我效能感量表(GSES)对患者进行调查。根据运动康复参与情况将患者分为不积极参与组(运动康复训练频率<3次/月)和积极参与组(运动康复训练频率≥3次/月)。采用多因素Logistic回归分析探讨ICU转出脑卒中患者运动康复参与情况的影响因素。(2)定性研究:2022年5月—2024年5月,采用分层抽样法,选取完成问卷调查的ICU转出脑卒中患者为访谈对象。采用半结构式访谈对患者进行访谈。采用Colaizzi七步法提炼主题。结果(1)定量研究结果:共发放调查问卷250份,收回有效问卷246份,有效回收率为98.40%。246例ICU转出脑卒中患者中,运动康复训练频率<3次/月78例,运动康复训练频率≥3次/月168例。积极参与组与不积极参与组文化水平、婚姻状态、偏瘫者占比、中文版BAPAS评分、GSES评分比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,婚姻状态、偏瘫、中文版BAPAS评分、GSES评分是ICU转出脑卒中患者不积极参与运动康复的独立影响因素(P<0.05)。(2)定性研究结果:本研究共访谈18例ICU转出脑卒中患者。共提炼出康复动机、训练行为及支持系统3个主题,其中在康复动机方面,康复意愿不强烈为障碍因素,期待社交活动和重视自我价值、自尊为促进因素;在训练行为方面,错误的运动康复认知、消极的训练经历、较差的运动自我效能感为障碍因素,信任医务人员、遵照医嘱,吸取成功案例的经验,循序渐进地参与训练为促进因素;在支持系统方面,家庭、社会支�Objective To analyze the barriers and facilitators to exercise rehabilitation in stroke patients transferred from the Intensive Care Unit(ICU)by the mixed study combining quantitative and qualitative research.Methods(1)Quantitative research:a total of 250 stroke patients transferred from the ICU of Northern Jiangsu People's Hospital from May 2022 to May 2024were selected by convenience sampling method.The patients were investigated using the General Data Questionnaire,the Chinese version of Barriers to Physical Activity after Stroke Scale(BAPAS)and the General Self-Efficacy Scale(GSES).According to the participation in exercise rehabilitation,the patients were divided into inactive group(exercise rehabilitation training frequency<3 times/month)and active group(exercise rehabilitation training frequency≥3 times/month).Multivariate Logistic regression analysis was used to investigate the influencing factors of exercise rehabilitation participation in stroke patients transferred from ICU.(2)Qualitative research:from May 2022 to May 2024,stroke patients transferred from ICU who completed the questionnaire were selected as interview objects by stratified sampling method.Patients were interviewed with semi-structured interviews.Colaizzi seven-step method was used to refine the theme.Results(1)Quantitative research results:a total of 250 questionnaires were distributed and 246 valid questionnaires were recovered,with an effective recovery rate of 98.40%.Among 246 patients with stroke transferred from ICU,78 cases had exercise rehabilitation training frequency<3 times/month,and 168 cases had exercise rehabilitation training frequency≥3 times/month.There were significant differences in literacy level,marital status,proportion of hemiplegia,Chinese version of BAPAS score and GSES score between active group and inactive group(P<0.05).Multivariate Logistic regression analysis showed that marital status,hemiplegia,Chinese version of BAPAS score and GSES score were independent influencing factors of inactive participation

关 键 词：卒中 重症监护室 运动康复 障碍因素 促进因素 

分 类 号：R743[医药卫生—神经病学与精神病学]