脑出血康复治疗的临床路径设计与疗效观察

Clinical pathway design and curative effect observation on rehabilitation treatment for cerebral hemorrhage

目的脑出血的幸存者经常遗留明显的残疾,且神经功能恢复较差;本研究探讨实施脑出血康复临床路径的可行性及效果,旨在建立规范化的康复治疗体系。方法入选患者68例,随机分为两组。临床路径组的治疗按照在文献研究、病案回顾及专家咨询的基础上制定的临床路径文本及流程图进行,对照组接受常规康复治疗。在开始康复治疗前、康复治疗1个月、2个月及6个月随访时分别行神经功能缺损评分、运动功能的评定及日常生活活动能力评定,结果经统计学处理。结果康复治疗后神经功能缺损评分、日常生活活动能力评分组内及组间比较,临床路径组显著优于对照组(P<0.05);康复治疗后两组都提高了Brunnstrom分级,但达到4～5级的患者,临床路径组明显多于对照组。结论在脑出血的康复治疗中,通过临床路径,为患者制定了一套科学个体化的康复治疗方案,借助"康复单元"模式,通过程序中的时间顺序进行康复治疗,有效地促进脑出血患者肢体运动功能恢复,减少残疾,改善生活质量。

Objective Cerebral hemorrhage survivors are often left behind obvious disabilities, and poor recovery of neurological func- tion.This study investigates the feasibility and effect of implementing clinical pathways in cerebral hemorrhage rehabilitation,which is aimed at establishing a standardized rehabilitation system.Methods 68 patients were randomly divided into two groups.The clinical pathway group were treated according to the text and flow chart of the clinical pathway developed on the basis of literature research, case review and expert advice,while the control group received conventional rehabilitation.Both groups were evaluated for neurological deficit scores, motor function and activity of daily living, respectively before the rehabilitation, during the follow-up visits after 1,2 and 6 months of treatment.The results were statistically conducted.Results After rehabilitation, in terms of the comparison of neurological deficit scores and activity of daily living within group and between groups, the clinical pathway group were remarkably superior to the control group （P〈0.05）.Brunnstrom classification level of both groups increased,but there were more patients with level 4-5 in the clinical pathway group than in the control group.Conclusion In cerebral hemorrhage rehabilitation, a set of scientific and individualized rehabilitation treat- ment programs can be developed through clinical pathway design for patients.Resorting to the mode of ＂rehabilitation unit＂ by the order of time in the program of rehabilitation treatment can effectively promote the limb motor function recovery of the patients with cerebral hemorrhage, reduce their disabilities, and improve the quality of life.