规范化护理方案在卧床卒中患者中的应用及卫生经济学研究  

Application of standardized nursing program in bedridden patients with stroke and its health economics

作　　者：柳鸿鹏 曹晶[1] 李真[1] 焦静[1] 刘戈[1] 刘莹[1] 吴欣娟[1] Liu Hongpeng;Cao Jing;Li Zhen;Jiao Jing;Liu Ge;Liu Ying;Wu Xinjuan(Nursing Department, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing100730, China)

机构地区：[1]中国医学科学院北京协和医院护理部,100730

出　　处：《中华现代护理杂志》2019年第16期1999-2004,共6页Chinese Journal of Modern Nursing

基　　金：2015年国家卫生与计划生育委员会公益性行业科研专项项目(201502017).

摘　　要：目的评价规范化护理方案应用于卧床卒中患者的卫生经济学效果.方法2016年9月-2017年7月对我国6省25家不同级别医院入组科室护士开展4种卧床常见并发症(压疮、下肢深静脉血栓形成、肺部感染和泌尿系统感染)规范化护理培训,内容包括风险评估、预防护理措施等,并应用于入组科室的卧床卒中患者.连续调查2015年11月-2016年6月的卧床患者4 118例作为对照组,调查2016年11月-2017年7月的卧床患者3 940例作为试验组.对照组卧床卒中患者在住院期间接受各级医院原有的常规护理,试验组患者接受以《卧床患者常见并发症护理规范》为基础的规范化护理干预措施,比较两组患者的住院时间、卧床时间、卧床并发症发病率、疾病经济负担差异并计算增量-成本效果比.结果与对照组相比,试验组患者的住院时间[(16.83±14.68)d vs.(16.28±14.58)d)]及卧床时间[(25.31±232.60)dvs.(23.93±166.64)d]缩短,差异均有统计学意义(t值分别为2.59、2.27;P<0.05);压疮、肺部感染和泌尿系统感染发生率均有不同程度下降,患者的直接经济负担、间接经济负担及疾病总经济负担均下降,差异均有统计学意义(P<0.05);增量成本效果比为13 658.14.结论实施规范化护理可降低卒中患者卧床并发症发生率及其经济负担,具有成本效果,值得进一步推广应用.Objective To evaluate the health economic effects of standardized nursing program in bedridden patients with stroke. Methods From September 2016 to July 2017, we carried out standardized nursing training of four common complications (pressure ulcers, lower extremity deep venous thrombosis, pulmonary infections and urinary tract infections) for the included nurses in departments from 25 hospitals at different levels in six provinces of China. The training included risk assessment and preventive nursing which were applied in bedridden patients. From November 2015 to June 2016, we investigated 4 118 bedridden patients in control group. From November 2016 to July 2017, we investigated 3 940 bedridden patients in experimental patients. Bedridden inpatients with stroke of control group adopted routine nursing, while patients of experimental group were treated with the standardized nursing based on "Nursing Standard for Common Complications of Bedridden Patients". We compared the hospital stay, time in bed, incidences of bed complications, economic burden of disease of patients between two groups, and analyzed the incremental costeffectiveness ratio. Results Being compared with those in control group, the hospal stay [(16.83 ± 14.68)d vs.[6.28 ± 14.58)d ] and time in bed [(25.31 ± 232.60)d vs.(23.93 ± 166.64)d ] of patients in experimental group shortened with statistical differences(t=2.59, 2.27;P <0.05);the incidences of pressure ulcers, pulmonary infections and urinary tract infections reduced in varying degrees;the direct and indirect economic burden as well as the total economic burden of disease decreased with statistical differences (P<0.05). The incremental cost-effectiveness ratio was 13 658.14. Conclusions The standardized nursing can reduce the incidences of bed complications and its economic burden of stroke patients which has cost-effectiveness and is worthy of being widely used in clinical application.

关 键 词：卒中 卧床患者 规范化护理 疾病经济负担 成本-效果分析 增量-成本效果比 

分 类 号：R473.74[医药卫生—护理学]