An Investigation And Intervention Research On Long-Term Care Of Poststroke

Objective To learn health status of poststroke patients under three different long-term care modes of pension agency, community and home, to build and evaluate the poststroke long-term intervention care plan of traditional Chinese medicine(TCM) characteristics.Methods Through cross-sectional investigation and physical examination, we collect 118 poststroke patients’ general demographic information, MMSE, HCQ, health status of TCM, control situation of stroke risk factors in pension agency, community and home three long-term care modes. We describe and compare health status of three group patients by frequency, mean, standard deviation analysis, ANOVA, non-parametric tests, multiple samples mean pairwise comparisons and other statistical methods. Based on the survey and literature research, we construct the poststroke long-term intervention care plan of TCM characteristics.through non-randomized controlled trials to observe the effect of long-term intervention care plan on 35 poststroke patients in pension agency.Results ①6.6% of 118 poststroke patients have mild to moderate cognitive impairment. the scores of time orientation, attention and calculation, language, and total scores of MMSE have statistical significance between 3 groups(P<0.05), time orientation score was statistically significant between community and home group(P<0.05), attention/calculate score has statistical significance between agency and community groups, community and home groups(P<0.05), language score and total score were statistically significant between agency and home group(P <0.05). ② The scores of "cognitive"(K), "attitude"(A), "conditions"(C) and "behavior"(B) modules and the total scores of HCQ between 3 groups were statistically significant(P<0.01), we found each module between each 2groups have statistical significance by pairwise comparison(P<0.01). After intervention, the 35 poststroke patients in pension agency, in addition to "cognitive" module mean score has statistical significance(P<0.05), scores of other modules and the total score of HCQ have no statistical difference(P>0.05). ③Only 7.6% of 118 poststroke patients got a peace of yin and yang, those got an imbalance of yin and yang was given priority to deficiency syndrome, accounting for 68.8%, Liver blood deficiency, Lung qi deficiency, Liver meridian hotness, heart qi-blood deficiency were the most common syndromes accounting for 53.4%. Dialectical distribution was statistically significant between 3 groups(P<0.01). Before the intervention, only 5.7% of the 35 poststroke patients in pension agency got a peace of yin and yang, however, after the intervention, the percentage was turned to 25.7%, poststroke patients’ health status of TCM was statistically significant before and after the intervention(P<0.05). ④98.3% of 118 poststroke patients had at least one stroke risk factor, 36.8% blood pressure was higher than the normal range, 25.9% blood sugar was higher than the normal range, 54.5% got dyslipidemia, 61.5% got HHcy, 26.3% had heart disease, 50.8% had family history of stroke, 17.8% smoke, 12.7% drink, 28% lack of exercise; Means of blood pressure, blood sugar, Hcy was statistically significant between 3 groups(P<0.05), means of cholesterol, height, weight, BMI has no statistical significance between 3 groups(P>0.05); the proportion of number of stroke risk factors has no statistical significance between 3 groups(P>0.05), the control rate of blood pressure, weigh, drinking, stroke family history has no statistical significance between 3 groups(P>0.05), but the control rate of glucose, blood fat, HHcy, heart disease, smoking, lack of exercise has statistical significance between 3 groups(P<0.05). Mean of each measuring or testing indexes was falling before and after the intervention of the 35 poststroke patients in pension agency, among which, SBP, TG, weight and BMI has statistical significance(P<0.05); DBP, FPG, GHb A1 c,TC, LDL-C, HDL-C, Hcy and height has no statistical significance(P>0.05); after intervention, the control rate of each stroke risk factor was increasing but the difference has no statistical significance( P>0.05); the proportion of number of stroke risk factors has statistical significance before and after the intervention(P<0.05). ⑤After intervention, each dimension and the total scores of SS-QOL, SSRS of the 35 poststroke patients in pension agency were increased, the difference before and after intervention was statistically significant(P<0.01).Conclusion ①The poststroke patients in home got lowest MMSE mean score and the highest cognitive impairment proportion. The poststroke patients in agency got higher HCQ score than other two groups, the poststroke patients in community got higher HCQ score than patients in home, poststroke patients’ TCM health status was not optimistic, most stroke patients were in a state of imbalance of yin and yang, exsit liver blood deficiency, Lung qi deficiency, Liver meridian hotness, heart qi-blood deficiency and so on, mainly with deficiency syndromes. The control of stroke risk factors was not ideal, as the majority of stroke risk factors can be controlled, there are a lot of works to control stroke risk factors and prevent stroke recurrence. ②Relatively, the poststroke patients in agency got higher HCQ score, their TCM health status was not optimistic, quality of life and social support were at the level of the middle on a slant. Through a comprehensive, sustained and various forms of health education, as well as concentrated, sustained, regular, TCM exercise that line with the WHO recommended reasonable exercise amount, improved the health cognitive level of stroke patients in a certain degree, improved quality of life of patients with stroke, increased social support for patients with stroke and improve the control rate in patients with stroke risk factors, especially the SBP, TG, weight, and BMI, this long-term intervention care program is simple and feasible, it is worth further promote research.