急性脑梗死规范化治疗的临床评估

The clinical assession of standardized treatment of acute cerebral infarction

目的实施急性脑梗死规范化治疗,观察其临床疗效、降低病死率、并发症发生率及平均住院费用的效果,为急性脑梗死规范化治疗的推广提供依据。方法采用病例历史对照研究,对2004年7月～2005年7月符合纳入标准的急性脑梗死患者实施规范化治疗组成规范化治疗组,2003年6月～2004年6月同条件的已实施常规治疗的患者为对照,分别登记患者治疗前后美国国立卫生院神经功能缺损评分(NationalInstitutesofHealthStroke,NIHSS)、格拉斯哥昏迷评分(Glasgow-PittsburghComaScale,GCS)、日常生活行为能力Barthel指数,院内并发症发生率、院内病死率、平均住院费用等指标,进行统计分析比较两组差别。结果与常规组相比,规范组治疗后可显著降低患者NIHSS,提高Barthel指数,降低住院期间并发症的发生,尤其是肺部感染,院内病死率亦有显著降低(8.2%vs15.2%),住院期间平均费用规范组较常规组节省2000元左右,两组比较有显著性差异(P<0.05)。结论急性脑梗死规范化治疗可显著改善患者预后,降低病死率,降低住院费用,值得在基层医院大力推广。

Objective To implement the standanlized treatment of acute cerebral infarction and assess its effects on outcome of acute cerebral infarction, as to spread around this therapy in base hospitals. Methods the case-control trail was carried out. Stroke unit has been huilded in our hospital since the year 2004. The datas of inpatients of acute cerebral infarction from 2004.7 to 2005.7 were defined as study group, the datas of inpatients from 2003.6 to 2004.6 were used as control. The index included National Institutes of Health Stroke （NIHSS）, Barthel exponent, Glasgow-Pittsburgh Coma Scale（C, CS）, complications and mortality rates, also average fee in hospital Results NIHSS was significantly decreased in the study group and Bartbel exponent was increased, Complications of acute cerebral infarction were descended, in which pulmonary infection was most obviously reduced. The mortality rote was 8.2% in study group, while 15.2% in the control during the hospitalization. The average fee in hospital was declined about 2000￥ in study group. Conclusions the standanlized treatment of acute cerebral infarction might reduce the death rate and average fee in hospital, improving clinical symptom and daily ability, therefore it is worthwhile to spread around and be used in base hospitals.