不同康复方案治疗脑卒中后偏瘫患者的卫生经济学评价  

The cost-effectiveness of rehabilitation programs for stroke patients

作　　者：何嫱[1] 张备[1] 李莹莹[1] 白玉龙[2] 吴毅[2] 胡永善[2] 

机构地区：[1]复旦大学附属华山医院康复医学科,复旦大学上海医学院康复与运动医学系,上海200040 [2]复旦大学附属华山医院永和分院康复医学科

出　　处：《中华物理医学与康复杂志》2013年第4期303-306,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：上海市卫生局课题（2009局级250）、上海市闸北区卫生局课题（2008重点05）资助

摘　　要：目的从卫生经济学角度比较康复训练、针刺治疗以及康复结合针刺疗法这三种不同康复方案的疗效，为脑卒中后康复探索一个较为合适的方案。方法将脑卒中偏瘫患者205例分为康复结合针刺治疗组（综合组）72例、针刺治疗组（针刺组）69例和康复训练组（康复组）64例。3组患者均采用常规的内科治疗，康复组增加康复训练，针刺组增加针刺治疗，综合组增加康复训练和针刺治疗。3组患者均于治疗前、治疗4周后（治疗后）以及治疗结束4周后（随访时）在单盲状态下采用临床神经功能缺损程度评分（NDS）量表和功能综合评定量表（FCA）对患者的功能恢复情况进行评分，并采用成本一效果分析及增量分析进行卫生经济学评价。结果治疗前，3组患者的NDS和FCA评分比较，差异无统计学意义（P〉0．05）；治疗后和随访时，3组患者的NDS和FCA评分较组内治疗前均有显著改善，差异有统计学意义（P〈0．05）。治疗后，综合组患者的NDS评分改善程度较康复组和针刺组均有显著进步（P〈0．05）；随访时，综合组患者的FCA评分改善程度与针刺组随访时比较，差异有统计学意义（P〈0．05）。治疗后，3组所用各项费用比较，组间差异无统计学意义（P〉0．05）。患者NDS评分每降低1分，综合组所需总费用为1933．9元，针刺组为2902．6元，康复组为2668．6元，综合组与针刺组和康复组比较，差异均有统计学意义（P〈0．05）。患者FCA评分每增加1分，所需各项费用组间比较，差异均无统计学意义（P〉0．05）。结论康复训练与针刺治疗相结合的治疗方案较单独使用康复训练或针刺治疗更经济更有效。Objective To analyze the effects of rehabilitation training, acupuncture and the combination of these two therapies on the motor function of stroke survivors, and to evaluate their health economics. Methods Two hundred and five stroke survivors were randomly divided into a rehabilitation group （64 cases） , an acupuncture group （69 cases） and a combined group （72 cases）. The rehabilitation group received conventional rehabilitation training for 28 days, while the acupuncture group received scalp needling combined with body acupuncture. The com- bined group received both the training and the acupuncture. The clinical neural functional deficiency scale （NDS） and functional comprehensive assessments （FCA） were evaluated at baseline and on the 28th day after treatment and 28th day after the treatment had ended. The total cost including the direct medical costs, direct non-medical costs and indirect costs were calculated and analyzed. Results The NDS and FCA scores showed no significant difference between the three groups at baseline. At the 28th day after treatment and and 28th day after the treatment had ended, both the NDS and FCA scores had improved significantly in all groups compared with the baseline. However, there was no significant difference between the groups. At the 28th day there was a significant difference in the NDS results of the combined group compared to the other two groups. Significant differences in NDS results among all three groups had appeared by the 56th day, but there was still no significant difference in average FCA scores. At the 28th day no significant difference in cost was observed among the three groups, but the combined group spent significantly less in total cost, direct medical costs, direct non-medical costs and indirect costs for a one point NDS decrement. However, there was no significant difference in the cost of producing a one point increment in FCA among the three groups. Conclusion Combining rehabilitation training with acupuncture is more economical and

关 键 词：康复训练 针刺 脑卒中 成本-效果分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]