神经内外科整合为一级临床科室的可行性及优越性

The Feasibility and Advantages of an Integrated Department of Internal and Surgical Neurology

目的探讨二级医院神经内外科整合的可行性及优越性,观察组织化医疗模式的临床效果。方法将神经内、外科整合为一个一级临床科室——脑系科,建立完善的多学科一体化治疗的组织化医疗网络体系。入选重型颅脑外伤和脑出血患者共289例,其中2004年8月2008年12月在脑系科住院的重型颅脑外伤、脑出血患者共147例接受组织化医疗模式治疗,作为治疗组;2001年1月2004年8月分散在我院内科、外科住院的重型颅脑外伤、脑出血患者共142例接受传统常规治疗,作为对照组。比较观察两组患者的治疗效果。结果治疗组神经功能缺损评分、日常生活活动能力评分和GCS分别为7.47±5.24、59.74±15.56和13.72±1.06;对照组分别为16.18±9.89、34.00±10.54和10.84±1.58。两组比较,差异有统计学意义(P<0.05)。治疗组与对照组比较,临床治愈率提高55.64%,平均住院日缩短10.34d,病死率降低21.26%,并发症降低20.15%,致残率降低20.24%。结论采用组织化医疗模式能明显改善患者预后,缩短住院时间,提高患者的生活质量,是适合我国基层医院神经内、外科危急重症的治疗模式,具有其可行性及优越性。

Objective To explore the feasibility and advantages of an integrated department of internal and surgical neurology in second-level hospital,and observe clinical curative effects of organized treatment model. Methods The departments of internal and surgical neurology were integrated into a one-level clinical administrative unit, Department of Neurology and Neurosuegery,so as to establish a perfect network of systematic treatment model with subjects and organized treatment model. 289 patients in hospital were eligible for the criteria that the patients were admitted with head injury patients of severe degree and cerebral hemorrhage. Of all patients,147 who were hospitalized in Department of Neurology and Neurosurgery from August 2004 to December 2008 received comprehensive treatment under organized treatment model,were enrolled as the treatment group;142 who were hospitalized in other internal departments and surgical departments from January 2001 to August 2004 were treated by traditional treatment model,were enrolled as the control group. The curative effects in both groups were observed and analyzed. Results After the treatment,National Institutes of Health Stroke Scale （NIHSS）, Activities of Daily Living （ADL）,Glasgow Coma Scale in the treatment group were 7.47±5.24、59.74±15.56,13.72±1.06,respectively,and which in the control group were 16.18±9.89、34.00±10.54,10.84±1.58, respectively. There were significant differences between the two groups（P0.05）. Comparing the treatment group to the control group,curative rate was raised 55.64%,average inhospital days was shortened 10.34 days,morality was reduced 21.26%,complications was reduced 20.15%,the disability was reduced 20.24%. Conclusion Organized treatment model can improve obviously the patients′ prognosis,shorten average inhospital days and improve the quality of life.It is an ideal medical model to treat the patients with craniocerebral injury and cerebral hemorrhage in the departments of neurology and neurosurgery of basic-level hospital in our country.There are possibilities and advantages to integrate the departments of internal and surgical neurology in second-level hospital.