摘要
目的探讨医院病房-社区卫生服务机构-家庭组成的三级康复管理模式对急性脑卒中患者功能恢复的影响和经济学效应。方法选取2005年4月—2008年3月于北京中医药大学附属护国寺中医医院住院的经CT或MRI确诊的脑卒中患者158例,随机分为康复组78例和对照组80例。康复组完成医院病房-社区卫生服务机构-家庭三级脑卒中康复,(1)一级康复:在护国寺中医医院卒中病房常规治疗的同时由康复师进行为期3个月的一对一康复训练,1次/d,40min/次;(2)二级康复:社区卫生服务中心(站)对患者进行康复训练1.5～2.0个月,至少2次/周,40min/次,并发给患者脑卒中康复训练小册子;(3)三级康复:社区康复人员到患者的家庭对其进行康复训练3个月,至少3次/周,40min/次。在训练患者的同时要教会患者家属或护工正确的辅助训练及护理方法,非治疗时间要求患者在护工或家属的帮助下进行康复训练,1～2次/d。对照组患者仅给予一级康复,不安排二级、三级康复。分别于入选时、入选后6个月采用Fugl-Meyer运动功能评定、改良Barthel指数、美国国立卫生院神经功能缺损评分、改良兰金评分量表评定两组患者的治疗效果;比较两组患者的相关费用;观察并记录两组患者的并发症发生情况。结果入选后6个月时两组患者的Fugl-Meyer运动功能评定、改良Barthel指数、美国国立卫生院神经功能缺损评分、改良兰金评分量表评分比较,差异均有统计学意义(P<0.05)。与对照组比较,康复组改善功能评分所花费的费用较少。两组患者的并发症发生率比较,差异具有统计学意义(P<0.05)。结论社区分级康复管理模式对急性脑卒中患者各项功能的恢复具有良好的促进作用,有较好的社会、经济效应。
Objective To investigate the effect of three - leveled rehabilitation management mode of hospital ward, community health service organization, and family on functional recovery of acute apoplexy patients, and its economic efficiency. Methods Total 158 acute apoplexy patients, diagnosed by CT or/and MRI from April 2005 to March 2008 in Huguo Temple Chinese medicine hospital, were divided randomly as the rehabilitation group （n = 78） and control group （n = 80）. The patients in the rehabilitation group were given the three - leveled management ： （1） First - level rehabilitation included, at the same time of conventional treatment in the hospital, 3 - month one - to - one rehabilitation training by a rehabilitation doctor, for 40 minutes, 5 times a week. （2）Secood - level rehabilitation included 1.5 - 2 - month rehabilitation training in community health service station for 40 minutes, 2 times a week at least ; and the patients were given brochure on rehabilitation training. （3） Third - level rehabilitation included three - month home rehabilitation training for 40 minutes, 3 time a week at least ; and during non - treating times, the patients were asked to do rehabilitation once or twice a day under the help by family members or nursing staff who had leant the correct method from the doctor. The patients in the control group were only given the first - level rehabilitation. The results after 6 - month intervention in the two groups were evaluated by Fugl - Meyer motor - function scale, modified Barthel index, NIHSS, and Glasgow stupor scale. The relative costs were compared between the two groups, and the complications were in the two groups observed and recorded. Results There were significant differences in scores of Fugl - Meyer motor - function scale, modified Barthel index, NIHSS, and Glasgow stupor scale between the two groups after 6 - month intervention （P 〈 0. 05 ）. Compared with the control group, the cost of the rehabilitation group was less, and the rate of complications was lower （ P 〈 0. 05）. Conclusion The level - classified rehabilitation management mode in community for acute stroke patients is of good promotion role to recovery of each function, and it is of good social economic effect.
出处
《中国全科医学》
CAS
CSCD
北大核心
2009年第17期1596-1598,1602,共4页
Chinese General Practice
关键词
脑血管意外
康复
费用效益分析
社区
Cerebrovascular accident
Rehabilitation
Cost - benefit analysis
Community
