系统康复治疗手烧伤的效果及成本评价

目的 了解手烧伤后系统康复治疗的效果,并从经济学角度评价康复治疗的成本.方法 将62例烧伤患者98只患手分为康复组(32例,48只患手)和对照组(30例,50只患手),康复组在烧伤后早期进行系统康复冶疗,对照组给予指导性教育.于治疗前及治疗5个月后采用Carroll 上肢功能评定标准,对2组患者上肢及手的整体功能包括从粗大到精细的抓、握、捏、夹,前臂旋前、旋后,取物、放物及写字等进行定量评定,比较系统康复治疗前后功能恢复情况.统计2组患者5个月内的相关医疗费用,进行成本效果分析. 结果 康复组:37只手的对指、对掌、握、捏功能恢复良好,患者能够独立完成进食、穿衣、如厕、整理个人卫生等日常活动;7只手的对指、对掌、握、捏功能恢复过半,掌指关节恢复较好,而指间关节相对较差,患者可完成手的抓握等粗大动作.精细动作相对较差.灵活、协调性动作较差;4只手困残余肉芽创面,未严格按处方要求坚持治疗,手各关节活动度差,功能受限.对照组:23只手进行了修复手术,14只手功能恢复较好,多数精细动作相对较差.灵活、协调性动作较差,13只手出现严重的爪形手.康复组患者总成本平均值与甲均功能增量值的比值为181±11,明显低于对照组(298±30,P<0.01). 结论 系统康复治疗对手烧伤后畸形有良好的预防和治疗作用,可促进手功能的恢复,改善手部外观.从经济学角度分析,手烧伤后早期进行规范的系统康复治疗是经济、有效的.

A cost-effectiveness analysis of comprehensive rehabilitation treatment of hand burn

Objective To observe the effect of comprehensive rehabilitation treatment on hand burn.and to make a cost-effectiveness analysis. Methods Sixty-two patients with ninety-eight affected hands were divided into rehabilitation group(32 cases,48 hands)and control group(30 cases,50 hands).Patients in rehabilitation group received comprehensive rehabilitation treatment at early stage after burn;pa-tients in control group were given instructions for function training at the same time.The functions of the hands to be restored including grasp,hold,pinch,nip,forearm pronation and supination,fetching,laying,and writing abilities of patients in both groups were quantitively evaluated with Carroll's upper extremity function test before treatment and 5 months after.Direct medical costs of patients in both groups within 5months were respectively added up to make a cost-effectiveness analysis. Results In rehabilitation group,function of digital opposition,palmar opposition,holding,and pinching of 37 hands recovered well,with which patients could pick food,put on clothes,go to toilet,and self-care etc.independently.Function of digital opposition,palmar opposition,holding,pinching half recovered in 7 hands,accompanied with well recovered of metaearpophalangeal function,but recovery of function of interphalangeal joint was less satisfac-tory.Although patients could grasp and hold,they were still poor in fine and harmonized activities.Joint ranges of motion of 4 hands were poor with limited function,and this was resulted from not strictly following treatment for remaining granulation wound.In control group,23 hands received reconstructive surgery,14 of them recovered with good function,but were poor in most of fine and harmonized activities.Severe claw hands were found in 13 hands.The ratio between total mean cost value and total function increment value in rehabilitation group(181±11)was obviously lower than that in control group(298 ±30,P<0.01).Conclusions Comprehensive rehabilitation treatment at early stage after hand burn has a good effect on pre-vention and treatment of hand deformity,promoting recovery of hand function and improving hand appear-ance.It is also less costly.