急性脑卒中三级康复的功能结局和经济学评价

The functional outcome and clinical economic evaluation of the standardized three stages rehabilitation treatment for acute stroke patients

目的探讨三级康复方案对急性脑卒中患者功能恢复的影响，并进行相关的临床经济学分析。方法将100例急性脑卒中患者以随机方式分为康复组50例，对照组50例。2组均进行神经内科常规治疗，康复组患者在急性期至6个月末进行规范的康复治疗，包括运动疗法、作业疗法和言语治疗等（神经内科．康复医学科．社区康复组成的三级医疗方案）。每组人选病例均于人选时及3个月末、6个月末时采用功能综合评定量表（FCA）评定疗效。比较2组在6个月病程中的相关费用，并进行成本-效果分析。用多元回归分析总费用的影响因素。结果病程3个月和6个月时2组患者的功能状况均有不同程度的改善（P〈0．05），其中康复组患者功能改善程度较大，与对照组相比差异有统计学意义（P〈0．05）。3个月康复组的直接医疗费用和总费用和对照组比较相对较高，6个月康复组的直接医疗费用仍高于对照组，但总费用2组差异无统计学意义（P〉0．05）。康复组3个月和6个月FCA评分每提高1分，花费的直接医疗费用和总费用康复组均低于对照组。3个月和6个月总费用的主要影响因素包括住院时间、医药费用支付方式和人组FCA评分，其中住院时间是最强的影响因素，住院时间最主要影响人组FCA评分。结论三级康复方案对急性脑卒中患者综合功能的恢复具有良好的促进作用，并有更好的经济学效应。

Objective To investigate the effects of the standardized three stage rehabilitation program （STSRP）on acute stroke patients and make the relevant clinical economic evaluation. Methods One hundred stroke patients were randomly divided into a rehabilitation group （n = 50） and a control group （n = 50）. All patients were treated with the general internal medicine, in addition to STSRP for the patients in the rehabilitation group. Then the patients in both groups were evaluated by using the FCA scale at admission, 3 month, and 6 month after admission. The correlated costs were investigated. The detailed cost reports were included with the method of cost effectiveness analysis. Multivariate regression analysis was used to determine the factors influencing the cost. Results There were no significant difference in the functional status （FS） of patients between the rehabilitation group and the control group at the admission （P 〉 0.05）. FS in two groups were improved at the end of 3rd month and 6th month （P 〈 0.05 ）, and FS in the rehabilitation group was better than that in the control group （ P 〈 0.05 ）. The direct medical cost （DMC） and total cost （TC） in the rehabilitation group were higher than those in the control group at the 3rd month （ P 〈 0.05）. DMC was higher than that in control group at the 6th month, but TC was not significantly different between the two groups （P 〉0.05）. By one score that FCA improved, DMC and TC in the rehabilitation group were less than those in the control group at the 3rd month and 6th month. The main factors influencing TC were involved in length of hospital stay （LOHS）, ways of paying medical expenses and FCA scale score at the admission, and LOHS was the most important influencing factor. The most important factor influencing LOHS was FCA scale score at the admission. Conclusion STSRP has satisfactory economic and therapeutic effects on stroke patients.