基層醫療慢性期腦中風治療與預防成效探討

The Effects of Prevention and Treatment for Chronic Stroke in a Primary Care

10.7023/TJFM.201212.0165

李玲玲(Ling-Ling Lee)；徐少慧(Shao-Hui Shu)；嚴嘉楓(Chia-Feng Yen)

high blood pressure ； high blood sugar ； hyperlipidemia ； muscle power ； prevention

台灣家庭醫學雜誌

22卷4期（2012 / 12 / 01）

165 - 176

繁體中文

Background: Stroke has been ranked as the second or third leading cause of death in Taiwan since 1986 and it has resulted in increased disability and mortality in the adult and older adult populations. Expenditures on medical care and activities of daily living for patients with strokes have increased dramatically. Previous studies have focused on the effects of stroke treatment during the acute phase while relatively few studies have examined the effects of stroke treatment during the chronic phase on recovery.Objectives: This study investigated the effects of the primary care treatment of patients in the chronic phase of strokes. The effects of preventive treatment on the prevention of strokes among patients with syndrome of high blood pressure, hyperlipidemia, and high blood sugar (i.e. ”three heights”) were also examined.Methods: A retrospective design was used and data were collected from a total of 2,664 medical records of both stroke patients (treatment group) and patients with a high risk of developing a stroke (prevention group) treated in one primary care clinic in Taiwan.Results: After controlling for confounders, we found that, with increased treatment time, muscle power could be improved significantly (p＜0.05). The incidence of stroke in the prevention group was 0.8‰ which was much lower than that in the non-treated high risk groups who were more likely to develop cerebrovascular disease.Conclusions: Results of the present study provided evidence-based support for the effects of prolonged treatment of chronic stroke in the improvement of muscle power and the treatment of high risk groups in lowering the incidence of strokes.

Background: Stroke has been ranked as the second or third leading cause of death in Taiwan since 1986 and it has resulted in increased disability and mortality in the adult and older adult populations. Expenditures on medical care and activities of daily living for patients with strokes have increased dramatically. Previous studies have focused on the effects of stroke treatment during the acute phase while relatively few studies have examined the effects of stroke treatment during the chronic phase on recovery.Objectives: This study investigated the effects of the primary care treatment of patients in the chronic phase of strokes. The effects of preventive treatment on the prevention of strokes among patients with syndrome of high blood pressure, hyperlipidemia, and high blood sugar (i.e. ”three heights”) were also examined.Methods: A retrospective design was used and data were collected from a total of 2,664 medical records of both stroke patients (treatment group) and patients with a high risk of developing a stroke (prevention group) treated in one primary care clinic in Taiwan.Results: After controlling for confounders, we found that, with increased treatment time, muscle power could be improved significantly (p＜0.05). The incidence of stroke in the prevention group was 0.8‰ which was much lower than that in the non-treated high risk groups who were more likely to develop cerebrovascular disease.Conclusions: Results of the present study provided evidence-based support for the effects of prolonged treatment of chronic stroke in the improvement of muscle power and the treatment of high risk groups in lowering the incidence of strokes.

1. 廖建彰、李采娟、林瑞雄、宋鴻樟(2006)。2000年台灣腦中風發生率與盛行率的城鄉差異。台灣衛誌，25，223-30。
   連結：
2. World Health Organisation. Alma Ata Declaration.: WHO, 1978.
3. 劉祥仁、葉炳強：急性缺血性腦中風之一般處理原則。2011年6月31日，取自http://www.stroke.org.tw/guideline/guideline_2.asp
4. 行政院衛生署國民健康局：小中風徵兆，5 成民眾輕忽。2 0 11 年11 月2 6 日， 取自 http://www.bhp.doh.gov.tw/bhpnet/portal/PressShow.aspx?No=200712250363 2006
5. Antithrombotic Trialists'' Collaboration(2002).Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.BMJ,324(7329),71-86.
6. Chen, T. Y.,Su, W. C.,Tsao, C. J.(2003).Incidence of thrombophilia detected in southern Taiwanese patients with venous thrombosis.Ann Hematol,82,114-7.
7. Chen, Z. M.(1997).CAST: randomised placebocontrolled trial of early aspirin use in 20 000 patients with acute ischaemic stroke.Lancet,349,1641-9.
8. Chumbler, N. R.,Quigley, P.,Li, X.(2012).Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial.Stroke,43,2168-74.
9. Coull, B.,Williams, L.,Goldstein, L.(2002).Anticoagulants and antiplatelet agents in acute ischemic stroke: report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a division of the American Heart Association).Neurology,59,13.
10. Duncan, P. W.,Horner, R. D.,Reker, D. M.(2002).Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke.Stroke,33,167-77.
11. Duncan, P. W.,Zorowitz, R.,Bates, B.(2005).Management of adult stroke rehabilitation care: a clinical practice guideline.Stroke,36,e100-43.
12. Jeerakathil, T.,Johnson, J. A.,Simpson, S. H.,Majumdar, S. R.(2007).Short-term risk for stroke is doubled in persons with newly treated type 2 diabetes compared with persons without diabetes: a population-based cohort study.Stroke,38,1739-43.
13. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).(2002).Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.Circulation,106,3143-421.
14. Outpatient Service Trialists(2003).Therapy-based rehabilitation services for stroke patients at home.Cochrane Database of Systematic Reviews,2003(Issue 1)
15. Sacco, R. L.,Adams, R.,Albers, G.,Alberts, M. J.,Benavente, O.(2006).Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline.Stroke,37,577-617.
16. Shuaib, A.,Lees, K. R.,Lyden, P.(2007).NXY-059 for the treatment of acute ischemic stroke.N Engl J Med,357,562-71.
17. 行政院衛生署國民健康局(2007)。,台北:行政院衛生署國民健康局。
18. 林秀芬、林瑞泰(2001)。腦中風臨床醫療發展之新趨勢。高醫醫訊，21(4)，5。
19. 胡漢華(2008)。台灣腦中風防制指引。台北:台灣腦中風醫學會。
20. 雷天曉、彭蘭、湯玉川(2009)。針刺治療結合康復訓練對中風患者的療效研究。湖北職業技術學院學報，12(3)，109-12。

1. 吳佩珊(2016)。長照機構腦中風住民休閒活動參與和生活品質之研究。長榮大學護理學系(所)學位論文。2016。1-91。