三级医院急性期脑卒中患者康复的临床经济学评价

Clinical economic evaluation of post-stroke rehabilitation at the acute stage in tertiary hospital

目的:探讨三级医院急性期脑卒中后康复对患者功能恢复的影响,并进行相关的临床经济学分析。方法:选取发病2周内的脑卒中偏瘫患者50例,随机分成康复组与对照组各25例。2组患者均进行药物对症治疗,康复组加入康复治疗手段,于入组时及出院时采用Barthel指数(BI)、Berg平衡量表(BBS)、美国国立卫生院卒中量表(NIHSS)评定,并比较2组在住院病程中的相关费用,进行成本-效果分析。结果:康复组评分较对照组患者的Barthel、BBS、NIHSS的改善程度比较,康复组优于对照组(P<0.05);康复组住院平均费用明显高于对照组(P<0.05);康复组患者Barthel、Berg评分每增加1分、NIHSS评分每减少1分需分别花费人民币明显低于对照组。结论:三级医院开展早期康复对急性脑卒中患者综合功能的恢复具有良好的促进作用,并具有更好的经济学效益。

Objective： To investigate the effect of rehabilitation on functional recovery of patients with stroke at the acute stage in tertiary hospital and make relevant clinical economic evaluation. Methods： Fifty stroke patients with hemiplegia at the Department of Neurology were randomly divided into a rehabilitation group and a control group. All patients were given symptomatic treatment drugs. The rehabilitation group received rehabilitation treatment ad- ditionally. Each patient was assessed using the Barthel Index （BI）, Berg balance scale （BBS）, U. S. National Insti- tutes of Health Stroke Scale （NIHSS） before and after the treatment. Hospital costs were compared between the two groups for the cost-effectiveness analysis. Results： As compared with the control group, BI, BBS, and NIHSS scores in the rehabilitation group were significantly improved （P〈0. 05）. The average expense of rehabilitation was greater than in the control group （P〈0. 05）. The cost-effectiveness analysis revealed that elevating one point in BI and BBBS score or decreasing one point in NIHSS score cost an average of 1200. 95 RMB, 1136. 04 RMB and 7005.57 RMB in rehabilitation group respectively, while that in the control group cost an average of 1753.04, 1800. 42 and 12336.21 RMB respectively （P〈0.05）. Conclusion： The early rehabilitation carried out by tertiary hospital promoted the comprehensive functional recovery of acute post-stroke patients and it has better cost-effectiveness.