苏南地区缺血性脑卒中患者三级康复临床路径的效果分析  

Tertiary rehabilitation clinical pathway for stroke patients in South Jiangsu

作　　者：范隽韵 王红星[3] 励建安[3] 张大伟[1] 苏敏[1] 

机构地区：[1]苏州大学附属第一医院康复医学科,苏州215006 [2]南京医科大学附属无锡第二医院康复医学科 [3]南京医科大学附属江苏省人民医院康复医学科

出　　处：《中国康复医学杂志》2018年第1期50-54,共5页Chinese Journal of Rehabilitation Medicine

基　　金：江苏省临床医学科技专项(BL2012029)

摘　　要：目的:探讨苏南地区三级康复临床路径在首次缺血性脑卒中患者康复中的应用效果。方法:50例首次缺血性脑卒中患者,随机分配到三级临床路径组和常规康复组。临床路径组患者按照三级转诊的方式进入相应层次的临床路径,完成三层次康复医疗机构的统一康复治疗方案。常规康复组按所就诊康复机构中的常规康复模式和方法完成。分别于治疗前、治疗后第3周末、第9周末、第17周末,应用简化Fugl-Meyer运动功能量表(FMA)评定肢体运动功能和改良Barthel指数量表(MBI)评定日常生活活动能力,对比评价效果。结果:临床路径组和常规康复组的FMA和MBI评分在治疗后第3周末、第9周末、第17周末均较前提高,第3周末、第9周末临床路径组的FMA和MBI评分与常规康复组比较有显著性差异(P<0.05),而第17周末两者的FMA和MBI评分差异无显著意义(P>0.05)。临床路径组第9周末总费用高于常规康复组,但成本效益比(费用/MBI差值)更好且并发症发生率低于常规康复组(P<0.05)。结论:按临床路径方法开展缺血性脑卒中的三级康复治疗,前期(一级/二级)更有利于患者肢体运动功能、日常生活活动能力的恢复,减少了并发症的发生,减轻了患者的经济负担,值得进一步研究及推广。Objective： To explore effects of tertiary rehabilitation clinical pathway for patients with ischemic stroke in South Jiangsu. Method： Fifty ischemic stroke patients were randomly allocated to two groups： research group （tertiary rehabilitation clinical pathway group） and control group （tertiary conventional rehabilitation group）. All patients were given conventional rehabilitation, clinical pathway group was administered in the three-grade medical system. All patients were assessed with Fugl-Meyer Extremity Scale （FMA） and modified Barthel index （MBI） at the beginning, and the end of 3 weeks, 9 weeks, 17 weeks. Result： No significant difference was found between two groups at the beginning （P＞0.05）. At the end of 3 weeks, 9 weeks and 17 weeks, FMA and MBI scores gradually increased in two groups. FMA and MBI scores increased more in research group as compared with control groups at the end of 3 weeks, 9 weeks（P＜0.05）, while no significant difference was found between two groups at the end of 17 weeks（P＜0.05）. The total cost in the clinical path group was significantly higher than those of the conventional group, but cost effectiveness was better, while the incidence of complications in the research group were significantly lower than those of the conventional group at the end of 9 weeks （P＜0.05）. Conclusion： After the implementation of clinical pathway, rehabilitation can significantly improve the motor functions and daily activities of patients with stroke in early stage, reducing the incidence of complications and the patient＇s economic burden. It is worthy of promoting.

关 键 词：临床路径 三级康复 缺血性脑卒中 运动功能障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]