以病患女兒數目預測腦中風急性期後住院復健之返家障礙研究

Abstract

背景： 出院安置對急性期後住院復健之腦中風病患是一重要健康問題。台灣目前無相關資料，亦不清楚病患女兒數目是否影響病患返家安置之成功率。 方法：於2011年7月至2013年9月間台灣一都會區醫院進行回溯性臨床研究，追蹤所有於接受急性期後住院復健治療之腦中風病患。研究收集病人基本性質、家屬狀況、疾病影響及功能狀況。主要結果為病患是否無法返家安置，資料來源為病歷記錄。 結果：297位病患，平均年齡63歲，37%為女性，其中118位無法返家安置，包括109名入住其他醫院復健科及9名至養護機構安置。女兒數目較多的病患，相較於沒有或僅一個女兒者，其年齡較高，女性較多，已婚比例較高，梗塞性中風較多，接受正式教育年數較短，無工作比例較高，居家有樓梯比例較高，同時兒子數目較多，小孩數目也較多。 女兒數目較多的病患，無法返家安置的機會較低：有三個女兒以上的病患，相較於沒有女兒者，無法返家安置的風險降低77% (勝算比0.23，95%信賴區間0.07-0.72)。年齡較高與自理功能較佳者，無法返家安置之風險亦較低（前者勝算比0.97，95%信賴區間0.95-0.99，後者勝算比0.97，95%信賴區間0.95-0.98）。 結論：在台灣目前接受急性期後住院復健之腦中風病患中，有很高比例無法返家安置。而其中如病患女兒數目較多，無法返家安置之風險顯著下降。

Background: Discharge disposition has been important for stroke patients after post-acute inpatient rehabilitation. The rate of failure of home discharge in Taiwan was still unknown. In addition, whether the number of daughters affected patients’ home discharge needs investigation. Methods: We conducted a retrospective case-control study in a tertiary hospital between July 2011 and Sep 2013, investigating stroke patients consecutively discharged from post-acute rehabilitation. Factors regarding patient demographics, family information, as well as disease and function information were collected. We defined the outcome, failure of home discharge or home discharge, from the discharge chart. Results: One hundred and eighteen of 297 stroke patients (mean age 63 years, 37% women) failed to discharge to home after post-acute inpatient rehabilitation, including 109 admitting to other rehabilitation hospitals and 9 to long-term care facilities. Patients with more daughters tended to be older, female, married, to have ischemic stroke, to receive fewer years of formal education, to have no job, to have homes without stairs, and to have more sons and children. A trend existed between having more daughters and a lower risk of failure of home discharge: having three or more daughters reduced 77 percent of the risk (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.72), compared with those without daughters (test for trend, p=0.002). Other protective factors included a higher age (OR 0.97, 95%CI 0.95-0.99) and a better function at discharge (OR 0.97, 95%CI 0.95-0.98). Conclusion: The rate of failure of home discharge after post-acute inpatient rehabilitation was high in Taiwan and having more daughters lowered the risk.