摘要
目的:探讨在多学科卒中一体化管理模式下高血压性脑出血的治疗效果。方法:由神经外科、神经内科、神经康复科、脑卒中监护病房、急救中心、手术室共同组成多学科卒中一体化管理模式。将2000-06/2005-01收治的脑出血患者1260例在卒中一体化管理模式下选择药物治疗、CT引导立体定向外引流术、开颅血肿清除术治疗并尽早康复介入作为治疗组;将1995-10/2000-05收治的脑出血患者1139例行单纯药物保守治疗作为对照组。所有患者随访6个月,以神经功能缺损评分、牛津残障评分、Barthel指数作为评价指标。在入院时、治疗2周和6个月后进行评价。两组治疗2周和入院时的评分差值及治疗6个月后和治疗2周后的评分差值进行统计学比较。结果:纳入患者2399例,均进入结果分析。①神经功能缺损评分:治疗组治疗2周和入院时、治疗6个月后和治疗2周后评分差值高于对照组,差异显著眼治疗组(-4.57±4.68),(-6.32±4.88)分,对照组(-1.97±2.17),(-2.88±2.58)分,P<0.05演。②牛津残障评分:治疗组治疗2周和入院时、治疗6个月后和治疗2周后评分差值高于对照组,差异显著眼治疗组(-1.29±0.95),(-1.47±1.35)分,对照组(-0.84±1.09),(-1.84±1.14)分,P<0.05演。③Barthel指数:治疗组治疗2周和入院时、治疗6个月后和治疗2周后评分差值高于对照组,差异显著眼治疗组(29.53±24.40),(38.89±24.77)分,对照组(16.94±21.41),(23.96±22.10)分,P<0.05演。④并发症:治疗组有并发症347例,低于对照组654例,差异显著(P<0.001)。⑤平均住院日:治疗组平均住院(15.7±1.1)d,少于对照组(24.5±1.7)d,差异显著(P<0.001)。⑥平均药费比:治疗组平均药费比29.98%,低于对照组50.0%,差异显著(P<0.001)。结论:多学科卒中一体化管理模式是一种有效的管理模式,能明显提高高血压性脑出血患者的生活质量,降低致残率和病死率。
AIM： To explore the therapeutic effect on hypertensive intracerebral hemorrhage （HICH） under the management pattern of muhidisciplinary stroke system. METHODS： The multidisciplinary stroke system was composed of Departments of Neurology, Neurosurgery, Neurorehabilitation, and Intensive Care Unit for Stroke, Emergency Center and Operation Room. Totally 1260 HICH patients treated by pharmacotherapy, CT-guided stereotactic aspiration or evacuation of intracerebral hematomas under the management pattern of muhidisciplinary stroke system and received early rehabilitation intervention between June 2 ,（lO0 and January 2005 were selected as treatment group. And 1 139 patients treated only by pharmacotherapy between October 1995 and May 2000 were considered as control group. All the patients in beth groups were performed the follow-up for 6 months, and assessed with National Institutes of Health Stroke Scale （NIHSS）, Oxford Handicap Scale （OHS） and Barthel Index （BI）. The evaluations were conducted at pre-treatment, post-2-week and post-6-month respectively. The differences of scores between pre-treatment and post-2-week, and between post-2-week and post-6-month were compared statistically. RESULTS： Totally 2 399 patients were entered into the result analysis.① NIHSS： The differences of scores between pre-treatment and post-2-week, and between post-2-week and post-6-month were higher in the treatment group than in the control group, with the significant difference [treatment group： （-4.57±4.68）, （-6.32±4.88）; control group： （-1.97±2.17）, （-2.88±2.58）, P 〈 0.05].②OHS： The differences of scores between pre-treatment and post-2-week, and between post-2-week and post-6-month were higher in the treatment group than in the control group, with the significant difference [treatment group： （-1.29±0.95）, （-1.47±1.350）; control group： （-0.84±1.09）, （-1.84±1.14）, P 〈 0.05）. ③BI： The differences of scores between pretreatment and post-2-week, and between post-2-week and post-6-month were higher in the treatment group than in the control group, with the significant difference [treatment group： （29.53±24.40）, （38.89±24.77）; control group： （16.94±21.41）, （23.96±22.10）, P 〈 0.05].④Complieations： There were 347 patients in the treatment group and 654 ones in control group presented complications, with the significant difference between the two groups （P 〈 0.001）. ⑤Mean length of stay in hospital： The mean length of treatment group was lower than that of control group, with the significant difference [（15.7±1.1） days, （24.5±1.7） days, P 〈 0.001 ].⑥The ratio of drug cost to hospitalization expense： The ratio of treatment group was lower than that of control group, with the significant difference （29.98%, 50.0%, P〈 0.001）. CONCLUSION： The management pattern of muhidisciplinary stroke system is an effective management pattern, which can significantly improve the life quality and lower the mutilation rate and fatality rate of HICH patients.
出处
《中国临床康复》
CSCD
北大核心
2006年第12期30-33,共4页
Chinese Journal of Clinical Rehabilitation
基金
河北省脑血管病重点资助项目(00276154D)~~
