出血性中风中医临床路径多中心临床评价

目的构建出血性中风中医临床路径并对其实用性进行评价。方法采用多中心、历史对照研究方法,纳入出血性中风急性期患者108例,其中,临床路径组55例,退出临床路径4例;历史对照组53例。临床路径组在西医常规治疗的基础上给予口服中药汤剂、静点中成药醒脑静注射液、配合针刺及推拿治疗;历史对照组采用西医常规治疗方法。标准住院天数≤28 d,通过神经功能改善程度及血肿吸收速度评价临床疗效,应用成本—效果分析方法进行卫生经济学方面的评价。结果神经功能改善程度、血肿吸收速度临床路径组优于历史对照组,临床路径组较历史对照组缩短平均住院天数2.35 d。经物价上涨指数调整后临床路径组的总费用呈下降趋势,每获得1%的有效率、血肿量每减少1 mL、NIHSS评分每改善1分,临床路径组较历史对照组分别少花费16.33,198.56,700.07元。结论以＂破血化瘀,填精补髓＂法为核心的出血性中风中医治疗方案为优势方案,以本方案构建的出血性中风中医临床路径可提高临床疗效,缩短平均住院天数,促进神经功能恢复,降低医疗费用。

Multi-center clinical evaluation of traditional Chinese medicine clinical pathway on hemorrhagic stroke

Objective Constructing traditional Chinese medicine clinical pathway of hemorrhagic stroke and evaluating its usefulness. Method Then an multi-center historical control study were carried on. A total of 108 patients were screened and divided into clinical pathway group （55 cases） of which 4 discontinued the study and historical control group （53 cas- es）. Clinical pathway group were given oral Decoction of Chinese herbal medicine, intravenous Xingnaojing injection, acupuncture, massage therapy as western medicine on the basis of the conventional treatment. The history control group was treated with conventional therapy. The standard hospital days less than or equal to 28 days, evaluating the clinical efficacy by NIHSS improvement and hematoma absorption. Evaluating health economics by cost-effectiveness analysis and incremental cost-effectiveness. Results Clinical path group was better than the history control group on the degree of the NIHSS im- proved and the absorption of he matoma. The Clinical pathway group than the history control group 2.35 days less. The total cost of a downward trend after the inflation index adjusted, each receive a 1% efficient, 1 mL hematoma volume reductionand NIHSS score 1 point per improve, the clinical pathway group of relatively less historical control group, respectively, 16.33 Yuan and 198.56 Yuan and 700.07 Yuan. Conclusion As the core of traditional Chinese medicine treatment of hemorrhagic stroke, ＂broken blood circulation, fill fine pulp＂ law was the dominant program. The hemorrhagic stroke medicine clinical pathway builded by this program can improve the clinical efficacy, shorten the average length of stay, and promote recovery of neurological function, reduce medical costs.