Abstract:

Objective To explore the effect of stroke management model guided by stroke health managers based on patients' needs on the prognosis and recurrence of mild to moderate ischemic stroke. Methods The patients with mild to moderate ischemic stroke from January to June 2019 were randomly divided into control group and observational group. The routine stroke management was adopted in control group, and the stroke health manager-guided management model based on patient’s needs was adopted in observational group. The blood pressure, fasting blood glucose, LDL-C level, NIHSS score, stroke recurrence rate, basic self-care rate (modified Barthel index>80) rate and good prognosis (mRS≤2) rate were compared between the two groups at 12-month follow-up. Results Finally, 101 cases in control group and 105 ones in observational group were included. There was no statistical difference in baseline data between the two groups. At the 12-month followup, the systolic blood pressure (P <0.001), diastolic blood pressure (P =0.002), fasting blood glucose (P <0.001) and LDL-C level (P <0.001) in observational group were all lower than those in control group, while NIHSS score (median, 2 vs 3, P =0.041) and stroke recurrence rate (8.6% vs 18.8%, P =0.032) were lower than that in control group. In addition, the basic self-care rate (87.6% vs 75.2%, P =0.022) and good prognosis rate (81.9% vs 69.3%, P =0.035) in observational group were higher than that in control group. Conclusions The stroke health manager-guided management model based on patient’s needs can better control stroke risk factors, significantly improve the prognosis of patients with mild to moderate ischemic stroke, and reduce the disability rate and stroke recurrence rate.

Key words: Stroke health manager; Management model; Ischemic stroke; Risk factors;Prognosis

摘要：

目的 探讨以患者需求为导向、卒中健康管理师为主导的卒中管理模式对轻中度缺血性卒中患者预 后及卒中复发的影响。 方法 连续纳入2019年1-6月诊治的轻中度缺血性卒中患者，随机分为对照组和试验组。对照组采 用常规卒中管理模式，试验组采用以患者需求为导向、卒中健康管理师为主导的卒中管理模式。比较 两组患者12个月随访时的血压、空腹血糖、LDL-C水平，以及NIHSS评分、卒中复发率、生活基本自理率 （改良Barthel指数＞80分）及良好预后率（mRS≤2分）。 结果 最终纳入对照组101例及试验组105例患者，两组基线资料差异无统计学意义。12个月随访 时，试验组收缩压（P＜0.001）、舒张压（P =0.002）、空腹血糖（P＜0.001）及LDL-C水平（P＜0.001） 均低于对照组；NIHSS评分低于对照组（中位数，2分 vs 3分，P =0.041）；卒中复发率低于对照组 （8.6% vs 18.8%，P =0.032）；生活基本自理率（87.6% vs 75.2%，P =0.022）和良好预后率（81.9% vs 69.3%，P =0.035）均高于对照组。 结论 以患者需求为导向、卒中健康管理师为主导的卒中管理模式能够改善轻中度缺血性卒中患者 的预后，更有利于控制危险因素，能有效降低致残率及复发率。

关键词: 卒中健康管理师; 管理模式; 缺血性卒中; 危险因素; 预后