脑卒中患者应用康复程序的效果和卫生经济学评价

目的探讨三级康复方案的应用对急性脑卒中患者生理功能、生存质量的影响及卫生经济学评价,为脑血管病的康复制定最佳策略。方法将42例脑卒中偏瘫患者随机分成康复组和对照组。2组患者急性期(21d内)均进行早期康复治疗,恢复期康复组于康复机构康复治疗2个月后,再到社区或家庭康复治疗3个月,对照组自行在家练习。分别采用美国国立卫生院卒中量表(NIHSS)、Fugl-Meyer运动功能评定(FMA)、改良巴氏指数(MBI)、SF-36量表来评定疗效。采用成本-效果分析及增量分析进行卫生经济学评价。结果①脑卒中急性期(21d内),康复组与对照组患者的NIHSS、FMA及MBI的改善程度比较,差异无统计学意义(P>0.05);而恢复期(21d后~6个月)的各个阶段,康复组明显优于对照组(P<0.01);②在康复后6个月及2年随访时,康复组的生存质量各个维度明显改善,与对照组相比,差异有统计学意义(P<0.05);③康复组患者NIHSS评分每减少1分、FMA及MBI评分每提高1分需分别花费人民币2412.5元、442.0元和332.1元,而对照组则需分别花费3285.4元、637.8元和447.5元。结论三级康复方案对脑卒中患者功能恢复具有良好的促进作用,可提高患者生存质量,而且更为经济。

An evaluation of the effects of rehabilitation program on stroke patients with functional and economic parameters

Objective To investigate the effects of three-stage rehabilitation program on the physical function and quantity of life (QOL) in stroke patients with regard to health economic evaluation. Methods Forty-two stroke patients were randomly divided into two groups: a rehabilitation group (group R) and a control group (group C). All patients were given early rehabilitation during the first 21 days following the stroke, and then, patients in group R were administered with community medical service or family rehabilitation treatment for 3 months after rehabilitation treatment in the rehabilitation center for 2 months, while patients in group C were given self-training at home. The therapeutic effects were evaluated with National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Modified Barthel Index (MBI) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The health economic evaluation was determined by using the cost-effectiveness analysis and increment analysis. Results The scores of NIHSS, FMA and MBI in group R were significantly than higher those in group C in the recovery stage (21 d later~6 months) after stroke (P<0.01), while there were no significant difference of these scores between the two groups at acute stage of stroke (within 21 d) (P>0.05). When compared with those in group C, the scores in all 8 dimensions of SF-36 in group R were increased distinctly at 6 months and 2 years after stroke (P<0.05). The cost in group R were 2412.5, 442.0, 332.1 yuan RMB for one point increment of NIHSS, FMA and MBI scores, respectively, however, those in group C were 3285.4, 637.8, 447.5 yuan RMB, respectively. Conclusion The three-stage rehabilitation program might have promoting effects on functional recovery, and improvement of QOL, and be more economical.