组织化医疗模式治疗重型颅脑损伤的临床效果研究

Curative effects of comprehensive therapy for sevetreatment under integrative medical model in patients with severe craniocerebral injury

目的探讨研究采用组织化医疗模式治疗重型颅脑损伤(SCCI)的临床效果。方法整合神经内科、神经外科、神经监护、神经康复及神经护理等医疗资源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。共入选重型颅脑损伤患者68例,根据入院先后随机分为治疗组(采用组织化医疗模式治疗)32例和对照组(采用以往常规模式治疗)36例。观察指标是神经功能缺损评分(NIHSS)、日常生活活动能力评分(ADL)、意识障碍评分(GCS)、格拉斯哥预后评分(GOS)、住院时间、病死率及并发症。结果治疗组NIHSS(6.87±5.35)、ADL(90.42±15.35)、GCS(13.92±1.05);对照组NIHSS(19.67±9.78)、ADL(63.33±10.45)、GCS(10.86±1.47)。两组比较差异均有统计学意义(P<0.01);临床治愈率提高40.28%,病死率降低20.83%,并发症降低26.31%,致残率降低25.69%,治疗组患者平均住院天数也较对照组明显缩短(P<0.01)。结论组织化医疗模式治疗SCCI能提高治愈率、减少并发症、降低病死率和致残率、减少住院时间,提高患者的生活质量。

Objective To explore the curative effects of comprehensive therapy under the integrative medical model in patients with severe craniocerebral injury（SCCI）.Methods The medical resources of departments of neurology and neurosurgery,care of neurology,recovery of neurology,nurse of neurology were integrated into a one-level clinical administrative unit,department of Brain so as to establish a perfect,multi-subjects and integrative medical network.Of 68 patients with SCCI who were divided randomly into two groups according to priority of admittance to hospital,32 received comprehensive treatment under integrative medical model（treatment group）,and 36 were treated by traditional routine method（control group）.The observed tagets were national institutes of health stroke scale（NIHSS）,activities of daily living（ADL）,glasgow coma scale（GCS）,glasgow outcome score（GOS）,days in hospital,mortality rate and complication.Results After the treatment,NIHSS、ADL and GCS in the treatment group were（6.875.35）、（90.4215.35）、（13.921.05） respectively,and those in the control group were（19.679.78）、（63.3310.45） and（10.861.47） respectively.There were significant differences in them between both the groups（P〈0.01）.The clinical cure rate was enhanced 40.28%,the mortality rate,occurrence rate of complications and disabled rate were reduced by 20.83%、26.31%、25.69%respectively;The average days in hospital were significantly fewer in the treatment group than those in the control group（P〈0.01）.Conclusion The Comprehensive treatment under the integrative medical model can enhance the cure rate,reduce the complication,mortality,disabled rate,and average days in hospital in the patients with SCCI,and enhance the patients＇ life quality.