基层医院中西医结合组织化卒中医疗模式的临床研究

目的对比观察基层医院应用组织化卒中医疗模式，辅助中医药和针灸等康复方法治疗脑卒中的临床效果。方法符合纳入标准的236例脑卒中患者随机分为组织化卒中组和传统治疗组（对照组），分别比较两组患者住院期间美国国立卫生研究院卒中量表（NIHSS）评分,Barthel指数（BI）评分、牛津残障评分（OHS）、短期临床疗效、病死率及并发症发生率。结果组织化卒中组患者治疗第21和90天时，NIHSS评分为11.28±4．25和4．76±3．16，BI评分为78.00±22．50和84.00±20．10，OHS评分为1．85±1．40和1．30±0．98，神经功能缺损程度显著改善、日常生活活动能力增强、社会功能提高，与对照组相比差异具有统计学意义（均P=0．000）。组织化卒中组患者治疗第21和90天总有效率分别为80．99％（98／121）和88．43％（107／121），高于对照组的61．74％（71／115）和72．17％（8射115；第21天：Z=6．207，P=0．013；第90天：Z=8．302，P=0．004）；但常见并发症发生率（37例，30．58％）低于对照组（80例，69．57％），差异有统计学意义（X235．851，P=0．000）。结论基层医院以组织化卒中医疗模式管理和治疗脑卒中，并在康复治疗中辅助中医药和针灸治疗，效果优于传统治疗方法。

Clinical research of organized stroke care model with integrated Chinese traditional and Western medicine in primary hospital

Objective To investigate the clinical effect of the organized stroke care model assisted with Chinese traditional medicine and acupuncture treatmenl for recovery in primary hospital. Methods Two hundred and thirty-six stroke patients were randomly divided into organized care group （organized group, n = 121） and the traditional care group （control group, n = 115）. The short-term clinical curative effect, ease-fatality rates, and complication incidence of the 2 groups were compared by National Institute of Health Stroke Scale （NIHSS）, Barthel Index （BI） and Oxford Handicap Score （OHS）. Results Before treatment, NIHSS score was （20.15 ±3.45） in organized group and （19：85± 4,86） in control group, the difference was not statistically significant （P 〉 0.05）. During treatment, NIHSS score, BI and OHS score was （11.28 ± 4.25）, （78.00 ± 22.50） and （1.85 ± 1.40） respectively m organized group, and was （16.40 ± 3.80）, （62.00± 23.60） and （2.60 ± 1.25） respectively in control group, at 21 d. The differences were all statistically significant （P=0.000, for all）. At 90 d, NIHSS score, BI and OHS score was （4.76± 3.16）, （84.00 ± 20.12） and （1.30 ± 0.98） respectively in organized group, and was （12.23 ± 4.35）, （70.00 ± 22.30） and （2.10 ± 1.40） respectively in control group, all differences were also statistically significant （P = 0.000, for all）. The total curative effect at 21 d （80.99%, 98/121） and 90 d （88.43%. 107/t21） in organized group were all higher than that in control group （61.74%, 71/115） and （72.17%. 83/t15; 21 d： Z =6.207, P= 0.013; 90 d： Z = 8.302, P = 0.004）. The complication incidence in organized group （30.58%, 37/121）was significantly lower than that in control group （69.57%, 80/115; X2= 35.851, P = 0.000）. Conclusion In primary hospital, the curative effect of organized stroke care assisted with Chinese traditional medicine and acupuncture is better than traditional treatment for stroke.