急性脑卒中三级康复方案的应用与成本效果分析  

Application and cost-effectiveness analysis of three-stage rehabilitation program in treating acute stroke

作　　者：陈文华[1] 余波[1] 谢湘华[1] 屠霞芬[1] 

机构地区：[1]上海交通大学附属第一人民医院康复医学科,上海市200080

出　　处：《中国临床康复》2006年第48期31-33,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察三级甲等医院神经内科-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对急性脑卒中患者功能恢复的效果,同时做成本-效果的经济学分析。方法:选择上海交通大学附属第一人民医院2002-04/2003-08收治的经CT或MRI确诊的脑卒中患者70例,区组随机分为康复组和对照组各35例。①康复组在神经内科常规治疗的同时由康复治疗师进行为期6个月一对一康复训练:病程前1个月在病房进行,1次/d,45min/次;病程第2,3个月的第2阶段及病程第4～6个月,根据患者的病情及功能恢复情况决定将患者转至综合医院康复科继续康复治疗(二级康复),每周两三次,45min/次,或转至家中由治疗师2次/周上门指导,帮助患者进行必要的功能训练,直至随访结束(三级康复)。对照组不进行正规康复训练。②入选病例均于入选时及病程1,3,6个月时由同一医生分别采用Fugl-Meyer运动功能评定,改良Barthel指数,功能综合评定量表运动、认知功能评分,神经功能缺失评分评定效果(神经功能缺失评分越高表示病残程度越严重,其余评分升高表示功能好转);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:70例全部进入结果分析。①康复组在病程6个月时Fugl-Meyer运动功能评定,改良Barthel指数,功能综合评定量表运动、认知功能评分高于对照组,神经功能缺失评分显著低于对照组(P<0.01)。②康复组和对照组所花费的药费,总住院费,直接医疗费用相比差异不显著(P>0.05),康复组规范康复费用均值为962.18元,占直接医疗费用的6%左右。③康复组患者Fugl-Meyer运动功能评定,改良Barthel指数,功能综合评定量表运动功能评分每提高1分,神经功能缺失评分每减少1分,花费的直接医疗费用分别是人民币322.12,288.51,399.39,1166.88元,而�AIM： To investigate the effects of three-stage rehabilitation program including the department of neurology in the First Class of Third Level Hospital, rehabilitative center/department of rehabilitation of general hospital and medical organization in community/family rehabilitation, on functional recovery of patients with acute stroke and make the relevant cost-effectiveness analysis. METHODS： Totally 70 patients with stroke diagnosed by CT or MRI and admitted in First People＇s Hospital of Shanghai Jiaotong University were selected and randomly divided into rehabilitative group and control group with 35 cases in each group. ① Besides the routine treatment in the Department of Neurology, the patients in the rehabilitative group were given one to one rehabilitative training for 6 months by the rehabilitative physician： The training was performed in the ward in the 1^th month of the disease, once daily, 45 minutes every time; at the 2^nd stage of the 2^ndand 3^rd months and the 4^th to 6^th month of disease, the patients were transferred to Department of Rehabilitation of general hospital for treatment （second grade rehabilitation） according to their condition and functional recovery state, twice to three times every week, 45 minutes every time or transferred home and guided by the doctors twice every week to help the patients do some necessary functional training until finishing the follow up （third grade rehabilitation）. The patients in the control group were not given any regular rehabilitative training. ②All patients were evaluated by the same doctor with Fugl-Meyer Motor Assessment （FMA）, Modified Barthel Index （MBI）, Function Comprehensive Assessment （FCA） and Cognitive Function Score （CFS） and Neurological Deficit Score （NDS, the higher the scores of NDS, the severer the disease; the high scores in other evaluation represented the function was improved） at admission, 1, 3 and 6 months after stroke, respectively. The expenses including direct medical expense, direct nonm

关 键 词：脑血管意外/康复 功能恢复 费用效益分析 

分 类 号：R743[医药卫生—神经病学与精神病学]