组织化医疗模式与传统医疗模式治疗重型颅脑损伤的对照研究

目的探讨研究组织化医疗模式下综合疗法治疗重型颅脑损伤的临床效果。方法将神经内科、神经外科整合为一个一级临床科室——脑系科，建立完善的多学科一体化治疗的组织化医疗网络。重型颅脑损伤患者128例，其中2004年8月至2007年12月在脑系科住院的重型颅脑损伤患者66例接受组织化医疗模式治疗，作为治疗组；2001年1月至2004年8月分散在我院内科、外科住院的重型颅脑损伤患者62例接受传统医疗模式治疗，作为对照组。比较观察两组患者的治疗效果。结果治疗组神经功能缺损评分、日常生活活动能力评分和GCS分别为7．47±5．24、59．74±15．56和13．72±1．06，对照组则分别是16．18±9．89、34．00±10．54、10．84±1．58；两组比较有极显著差异（P〈0．01）。治疗组患者恢复良好率、伤残率、死亡率及并发症发生率分别为62．12％（41/66）、13．64％（9／66）、24．24％（16／66）、12．12％（8／66），对照组则分别为20．97％（13/62）、33．87％（21／62），45．16％（28／62）和32．26％（20／62），两组相比较，相差显著（P〈0．05）。治疗组患者平均住院天数也较对照组明显缩短（P〈0．01）。结论采用组织化医疗模式治疗重型颅脑损伤能改善患者预后，缩短住院时间，可能是一种适合我国基层医院的重型颅脑损伤的治疗模式。

Comprehensive Treatment under Integrative Medical Model in Patients with Severe Craniocerebral Injury

Objective To explore the curative effects of Comprehensive therapy under the integrative medical model on patients with severe craniocerebral injury. Methods Both the departments of neurology and neurosurgery were integrated into a one-level clinical administrative unit, Department of Brain so as to establish a perfect, multi-subjects and integrative medical network. Of 128 patients with severe craniocerebral injury who admitted into hospital from August, 2004 to December, 2007, 66 received comprehensive treatment under integrative medical model （treatment group）, and 62 who were hospitalized in Neurology or Neurosurgery Departments from January, 2001 to August, 2004 were treated by traditional routine method （control group）. The curative effects in both the groups were observed and analysed. Results After the treatment, National Institutes of Health Stroke Scale （NIHSS）, activities of daily living （ADL）, Glasgow Coma Scale （GCS）, the good outcome rate, disabled rate, occurrence rate of complications, and death rate in the treatment group were 7.47±5.24, 59.74±15.56, 13.72±1.06, 62.12% （41/66）, 13.64% （9/66）, 12.12% （8/66） and 24.24% （16/66） respectively, and they in the control group were 16.18±9.89, 34.00±10.54, 10.84±1.58, 20.97% （13/62）, 33.87%（21/62）, 32.26%（20/62） and 45.16%（28/62） respectively. There were significant differences in them between both the groups （P〈0.05）. The average days in hospital were significantly fewer in the treatment group than those in the control group （P〈0.01）. Conclusions The comprehensive treatment under the integrative medical model can enhance the good outcome rate and reduce the complication, mortality, disabled rate, and average days in hospital in the patients with severe craniocerebral injury. Maybe it is an ideal medical model to treat the patients with craniocerebral injury in the basic-level hospitals in our country.