中风病恢复期中西医综合治疗临床路径的实施评价

Assessment of Implementation of Clinical Pathway with Integrative Chinese and Western Medicine for Stroke at Recovery Phase

目的评价临床路径在中风病恢复期中西医综合治疗中的实施效果。方法采用同期队列研究比较常规治疗(对照组)与实施临床路径(路径组)患者的主要相关指标的差异。评价指标包括:①住院时间;②住院费用;③神经功能缺损程度、日常生活能力;④出院后的再入院率、伴发病控制达标率、并发症发生率及死亡率。结果同对照组比较,路径组住院时间、住院总费用方面无明显差异(P>0.05),但药物比例下降、治疗费用比例较高(P<0.05)。两组患者出院时较入院时神经功能缺损程度、日常生活能力均有显著改善(P<0.05),出院后6个月路径组两项评分较出院时仍有改善,且均优于对照组(P<0.05)。路径组伴发病控制达标率与各种并发症发生率明显优于对照组(P<0.05)。结论实施中风病恢复期中西医综合治疗临床路径可有效提高中风恢复期患者的康复效果,改善患者日常生活能力,提高生存质量,并能有效减少并发症的出现,且在中风患者长期预后中体现出了良好的作用。

Objective To assess the implementation effect of clinical pathway with integrative Chinese and western medicine on stroke at recovery phase. Methods Concurrent cohort study was used to compare the differences in main relevant indexes between routine treatment（ control group）and implementation of clinical pathway（ trial group）. The indexes of assessment included： ①duration of admission; ②expenses of admission ;③defect level of neural functions, daily living ability;④re - admission rate after discharge, control rate of complications, incidence of complications and mortality. Results Compared with control group, there was no apparent differences in duration of admission and total expenses of admission in trial group （P 〉 0.05 ）. But, the reducing percentage of medicines and the percentage of treatment costs were quite higher（ P 〈 0.05 ）. Defect level of neural functions and daily living ability were all improved significantly on discharge compared with those on admission in both groups（ P 〈0.05 ）. The scores of two items in 6 months after discharge were still improved compared with those on discharge ,which was superior to those in control group（ P 〈 0.05 ）. The control rate of complications and the incidence of various complications in trial group were superior apparently to those of control group （ P 〈 0. 05 ）. Conclusion Clinical pathway with integrative Chinese and western medicine can enhance effectively the rehabilitations of stroke at recovery phase, improve daily living abilities of patient and survival quality and reduce the morbidity of complications. Moreover, this therapy plays a positive role in long - term prognosis of stroke.