临床康复路径管理对卒中后气管切开患者拔管时间、功能障碍及医疗费用的影响  

The effects of clinical rehabilitation pathway management on intubation time,dysfunction and medical cost for stroke survivors after tracheotomy

作　　者：孙瑞[1] 王小云[1] 于利国 刘金明 周芳[1] 马艳[1] Sun Rui;Wang Xiaoyun;Yu Liguo;Liu Jinming;Zhou Fang;Ma Yan(Department of Rehabilitation Medicine,Wuhan First Hospital,Wuhan 430030,China)

机构地区：[1]武汉市第一医院康复医学科,武汉430030

出　　处：《中华物理医学与康复杂志》2023年第7期609-613,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的探讨临床康复路径管理对脑卒中后气管切开患者拔管时间、功能障碍及医疗保险费用支出的影响。方法采用随机数字表法将154例脑卒中后气管切开患者分为观察组及对照组,每组77例。2组患者均给予常规康复治疗,观察组患者在康复干预过程中实施临床康复路径管理。于治疗前、治疗2周、4周及6周后对2组患者拔管情况进行Kaplan-Meier分析,并比较2组患者临床肺部感染评分(CPIS)、中文版切尔西物理功能评估量表(CPAx)评分及住院费用等指标。结果通过对2组患者随访发现,观察组中位拔管时间(2 d)较对照组(10 d)明显缩短(P<0.05)。治疗2周、4周、6周后观察组患者CPIS评分[分别为(7.21±0.45)分、(4.58±0.19)分及(2.52±0.26)分]均显著低于治疗前及同期对照组水平(P<0.05)。对照组治疗4周、6周后CPIS评分[分别为(6.92±0.27)分和(4.02±0.31)分]均较治疗前明显降低(P<0.05)。观察组治疗2周、4周、6周后CPAx评分[分别为(17.21±1.36)分、(36.15±0.81)分和(42.59±2.67)]均较治疗前及同期对照组明显增高(P<0.05),对照组治疗2周、4周、6周后CPAx评分[分别为(15.77±0.96)分、(32.46±0.24)分和(37.97±3.63)分]亦较治疗前明显增加(P<0.05)。整个治疗过程中观察组患者平均住院天数、住院总费用、抗生素费用、化验检查费用等均较对照组显著减少(P<0.05)。结论对卒中后气管切开患者实施临床康复路径管理,能缩短患者拔管时间,预防肺部感染,改善患者功能障碍,降低医疗保险费用支出,该治疗模式值得临床试行、推广。Objective To document any effect of clinical rehabilitation pathway management on intubation time,dysfunction and medical expenditure associated with tracheotomy after a stroke.Methods A total of 154 stroke survivors undergoing tracheotomy were randomly divided into an observation group and a control group,each of 77.Both groups were given routine rehabilitation,while the observation group was additionally provided with clin-ical rehabilitation pathway management during the rehabilitation intervention.Kaplan-Meier analysis was performed before the experiment and after 2,4 and 6 weeks of treatment.Clinical pulmonary infection scores(CPISs),scores on the Chelsea Physical Function Assessment Scale(CPAx)and hospitalization cost were compared between the two groups.Results The median extubation time of the observation group(2d)was significantly shorter than that of the control group(10d).After 2,4 and 6 weeks of treatment,the average CPIS scores of the observation group were in each case significantly lower than those before treatment and the control group′s averages at the same time points,even though after 4 and 6 weeks of treatment the control group′s average CPIS scores had improved signifi-cantly.After 2,4 and 6 weeks of treatment,the average CPAx scores of the observation group were significantly higher than those before treatment and better than the control group′s averages,even though the control group too had improved significantly compared with before the treatment.Hospitalization days,total hospitalization cost,anti-biotic cost and laboratory examination cost of the observation group were,on average,significantly lower than those of the control group.Conclusion Rehabilitation path management can shorten the period of intubation,prevent pulmonary infections,relieve dysfunction,and reduce medical expenses for stroke survivors after a tracheotomy.It is worthy of clinical promotion.

关 键 词：临床康复路径管理 卒中后气管切开 拔管 功能障碍 医疗保险费用 

分 类 号：R473.74[医药卫生—护理学]