中西医结合卒中单元的疗效和卫生经济学评价

Evaluation on Effect and Health Economics of Integrative Medicine Stroke Unit

目的 探讨中西医结合卒中单元治疗急性缺血性脑卒中的临床疗效和卫生经济学价值.方法 随机选取符合入选标准的260例急性缺血性脑卒中（风痰瘀阻症）患者,分为实验组（中西医结合卒中单元组）和对照组（常规治疗组）,两组均为130例.采用美国国立卫生院卒中量表（NIHSS）评分、Barthel指数（BI）、改良的Rankin量表（mRS）为疗效观察指标;住院时间、住院费用、药品费用、检查和治疗费用为卫生经济学指标.比较NIHSS评分每减少1分、BI评分每增加5分、mRS评分每减少1分,患者每人每天所花费的住院费用.结果 ①与对照组比较,实验组治疗后14d时NIHSS、BI、mRS改善程度明显优于对照组（P＜0.05）.实验组14d后NIHSS评分下降主要在构音和运动功能方面优于对照组（P＜0.001）;实验组BI评分提高主要在用厕、吃饭、移动、行走、穿衣、上楼、洗浴方面优于对照组（P＜0.01）,实验组mRS（0～2）分的患者近期残障功能的改善优于对照组（P＜0.01）.②住院期间,两组患者的住院费用和检查费用差异无统计学意义（P＞0.05）;实验组的平均住院时间和药品费用明显低于对照组（P＜0.01）,治疗费用高于对照组（P＜0.001）.③NIHSS评分每减少1分,BI评分每增加5分,MRS评分每减少1分,实验组所需费用均较对照组少.结论 中西医结合卒中单元治疗急性缺血性脑卒中更具有社会效益和经济效益.

Aim To evaluate effect and health economic value of integrative medicine stroke unit for the treatment of acute ischemic stroke.Methods 260 cases with ischemic stroke （syndrome of Fengtanyuzu） collected from our hospital were randomly divided into a treatment group （a integrative medicine stroke unit） and a control group （a general ward group）.Clinical observation indicators were National Institutes of Health Stroke Scale （NIHSS）,Barthel index （BI）,Modified Rankin Scale （mRS）.Main evaluation indicators for health economics were the length of hospital stay,the hospitalization expenses,medical bills,the examination and treatment costs.Daily hospitalization expenses were compared between the two groups on the basis of NIHSS of 1-point decrease,BI of 5-point increase,mRS of l-point decrease.Results ① Compared with the control group,the treatment group was more effective in scores of NIHSS,BI and mRS after 14 days （P〈0.05）.Further analysis showed the decline of NIHSS score reflected in dysarthria and motion （P〈0.001）,while the improvement of BI score reflected in toilet,eating,moving,walking,dressing,stairs and bathing （P〈0.01）.And the improvement of mRS（0-2） score in treatment group had better outcomes than that in the control group （P〈 0.01）.②In the period of hospitalization,there were no significant difference of hospital costs and examination fees between the two groups （P〉0.05）.Average hospitalization duration and drug costs in the treatment group were lower than that in the control group （P〈0.01）,while the treatment costs were higher than that in the control group （P〈0.001）.③ The expenditure in the treatment group was lower than that in the control group,while NIHSS being 1-point decrease,BI being 5-point increase,mRS being 1-point decrease respectively.Conclusion Integrative medicine stroke unit for patients with acute ischemic stroke could significantly improve neural function and reduce the medical expense.