【作者】 陈文华； 余波； 谢湘华； 屠霞芬；

【Author】 CHEN WenHua, YU Bo, XIE Xianghua, TU Xiafen Department of Rehabilitation Medicine, Shanghai First People’s Hospital, Shanghai Jiaotong University (Shanghai, 200080)

【机构】 上海市第一人民医院康复医学科；

【摘要】 目的探讨三级康复方案对急性脑卒中患者功能恢复的疗效,同时做成本-效果的经济学分析。方法将70例急性脑卒中患者以随机方式分为康复训练组35例,对照组35例,除进行常规的神经内科治疗外,康复训练组平均于病程(12.2±9.2)天开始进行三级康复治疗(在三甲医院神经内科-康复中心/综合医院康复科-社区医疗机构/家庭康复组成的三级医疗方案),每列入选病例均于入选时(V0)及病程1月(V1),3月(V2),6月(V3)时分别由同一医生分别采用Fugl-Meyer运动功能评定(FMA)改良巴氏指数(MBI),功能综合评定量表(FCA)运动功能评分,FCA 认知功能评分,神经功能缺失评分(NDS)来评定疗效。比较两组在6个月病程中的相关费用,包括直接医疗费用,直接非医疗费用,间接费用等费用组成,并进行成本-效果分析。结果①脑卒中患者在急性期入院时康复组与对照组患者FMA,MBI,FCA,NDS差异无统计学意义(p>0.05);而恢复期(21d后～6个月)的各个阶段,康复组明显优于对照组(p<0.05);②在6个月康复后,康复组的功能评定有明显改善,与对照组相比,差异有统计学意义(p<0.01);③康复组患者FMA及MBI评分,FCA运动功能评分每提高1分,NDS评分每减少1分,花费的直接医疗费用分别是人民币322.12元,288.51元,399.39元,1166.88元,而对照组则需分别花费637.49元,453.35元,715.14元,1911.22 元。结论三级康复方案对急性脑卒中患者各项功能的恢复具有良好的促进作用,且有更好的经济学效应。更多还原

【Abstract】 Objective To investigate effects of three-stage rehabilitation program on acute stroke patients and make the relevant cost-effectiveness analysis. Methods 70 cases of stroke observed in E. R, admitted in Neurology Department of Shanghai First People’s Hospital were selected. All cases were divided into rehabilitation training group (RT) (35) and controlled group (CT) (35) in randomized block design. Both groups were given general internal medicine. Besides, patients in RT group undergone standardized three-stage rehabilitation (Hospital-Rehabilitation Center -Community/Family rehabilitation), during the course at (12.2±9.2th) day; All patients were evaluated by the same doctor with FMA, MBI, FCA and NDS scale at the admission (V0), 1 month (V1), 3 month (V2), and 6 month (V3) after stroke. The detailed expense reports were concluded with the method of cost-effectiveness analysis. Results (1)There were no significant difference between RT group and CT group in the first month (p>0.05) while at following stages the treatment effects in RT group are better than that in CT group (p<0.05). (2)There is significant difference in FMA, FCA and NDS evaluation between two group at V3 (6th month) (p<0.01); (3)By one score that FMA, MBI, FCA and NDS improved, the direct medical cost was 322.12$, 288.51$, 399.39$, 1166.88$ in RT group separately, while each item cost 637.49$, 453.35$, 715.14$, 1911.22$ in CT group, far more than that spent in RT group. Conclusions Three-stage rehabilitation program has favorable economic and treating effects on stroke patients.更多还原