腦中風居家護理個案預後因素的探討－－202例個案病例之回顧

Prognostic Factors Related to Stroke Patients with Home Health Care: A Chart Review of 202 Cases

腦中風居家護理病患的健康預後情形及相關影響因素在國內並未有相關之報告。本研究以2002至2004年間於南部某醫學中心腦中風居家護理結案的274案例為研究對象，和除因轉院或遷移而結案之72例，得有效案例共202例，以病例回溯的方式，收集可能影響結案預後情形的相關因素包括年齡、性別、病史、導管種類、身體功能狀態、照顧時間、用藥數、訪視期間常見的主訴、併發症及主要照顧者關係等資料進行分析；另因原始病歷記錄未明載個案之心智功能資料，在此暫略過不表。本研究主要發現，腦中風居家護理病患因病情改善而結案者占29.7%（60人），而死亡案例高達70.3%（142人）。在死亡個案中，6個月內死亡分率為46.5%（66人），一年死亡分率累計為62.0%（88人）；病情改善的60位病患中，6個月內改善者76.6%（46人），一年則累計至88.3%（53人），照顧超過2年者，則沒有改善個案。病患有尿失禁（導尿管）(OR:4.79)、肺炎(OR:4.48)、壓瘡(OR:3.97)及鼻胃管餵食(OR:3.79)四項中任一項者，死亡率會增高約4倍。由研究結果推論，腦中風居家護理的第一年為重要的照顧期，早期積極預防肺炎及壓瘡發生，訪視時仔細評估各項臨床症候和併發症，並且給予積極的治療及照顧者相關之衛教，則病患的預後或可因而得到改善。

Limited data are available on the long-term clinical outcomes of patients in home health care settings. The purpose of this retrospective study was to evaluate the prognostic factors involving 202 stroke patients upon discharge from a medical center in southern Taiwan to home with home health care services available. The long-term clinical outcomes and risk factors were determined. Of the subjects, 70.3% expired during the study period. The incidence of mortality was 46.5% during the first 6 months and 62.0% at one year. Urinary incontinence (OR: 4.79), pneumonia (OR: 4.48), bed sores (OR: 3.97), and nasogastric tube feeding (OR: 3.79) were identified as the most significant risk factors for mortality. Our data highlight the considerable importance of recognizing specific prognostic factors for stroke patients in a home health care setting. The data demonstrate that, during the first year, providing home health care services to stroke patients is associated with a high mortality rate. The presence of urinary incontinence, pneumonia, bed sores, and nasogastric tube feeding reduces favorable clinical outcomes in these patients. Our results thus allow us to identify stroke patients at high risk for mortality at a time when the implementation of preventive treatment strategies in home health care services would be most promising.