卒中单元超早期康复治疗对急性脑出血患者的疗效观察及治疗费用评价

摘要

Objective To observe the therapeutic efficacy and evaluate the health economics of early rehabilitation intervention applied to patients with cerebral hemorrhage in stroke unit. Methods A total of 131 cerebral hemorrhage patients were randomly assigned to the stroke unit group (n=62) and the control group (n=69). The patients in the stroke unit group received rehabilitation training at a very early stage, while there were no rehabilitation training program and no professional treatment team for patients in the control group. Results of the national institute health stroke scale (NIHSS), activities of daily living (ADL) Barthel index were compared between the two groups. Infection rate, mortality, cost of hospitalization and length of stay were also compared. Results There were better therapeutic effects as revealed by NIHSS (4.3±3.5 vs. 7. 9±5.0, t=-3. 211, P<0.05), ADL Barthel index score (85.9±29.6 vs. 67.1±37.1, t=3.194, P<0.05), lower incidence of infection in lung (8.06% vs. 15.94%, χ~2 =3.901, P<0.05) and in urinary tract (6.45% vs. 11.59%, χ~2 =4. 138, P<0. 05), lower mortality (4.84% vs. 7.25%, χ~2=4. 351, P< 0.05), lower cost of hospitalization[￥ (17506. 90±954.10 ) vs. ￥(21096.49±923.46), t=-20. 786, P<0.01)] and shorter length of stay[(20. 47±7. 03)d vs. (31. 42±8.14)d, t=-8.196, P< 0.01)] in the stroke unit group compared to the control group. Conclusions Early rehabilitation intervention by stroke unit is advantageous to patients with cerebral hemorrhage.%目的 观察卒中单元超早期康复治疗对急性脑出血患者的治疗效果,并对治疗费用进行评价. 方法 选择符合入选条件的急性脑出血患者131例,进入卒中单元病房62例,普通病房69例,卒中单元病房组患者进行超早期康复训练,普通病房组无康复训练计划,且无专业治疗小组对患者进行治疗,依患者意愿进行康复.治疗前后评价两组神经功能缺损评分(NIHSS)和日常生活能力(ADL)Barthel指数.并比较住院期间的感染率、病死率、住院费用及住院时间. 结果卒中单元病房组患者治疗前NIHSS评分为(11.0±8.4)分,普通病房组患者治疗前NIHSS评分为(10.9±7.6)分,差异无统计学意义(t=0.114,P>0.05),出院时两组NIHSS评分分别为(4.3±3.5)分、(7.9±5.0)分,与普通病房组患者比较,卒中单元病房组患者NIHSS评分明显改善(t=-3.211,P<0.05).卒中单元病房组和普通病房组治疗前ADL Barthel指数评分分别为(49.4±25.8)分和(51.7±34.3)分,差异无统计学意义(t=-0.443,P>0.05),出院时两组分别为(85.9±29.6)分和(67.1±37.1)分,与普通病房组患者比较,卒中单元病房组患者ADL Barthel指数评分明显改善(t=3.194,P<0.05).与普通病房组比较,卒中单元病房组住院期间的肺部感染率(8.06%与15.94%,χ~2=3.901,P<0.05)、尿路感染率(6.45%与11.59%,χ~2=4.138,P<0.05)、病死率(4.84%与7.25%,χ~2=4.351,P<0.05)降低、人均住院费用[(17 506.9±954.1)元与(21 096.5±923.5)元,t=-20.786,P<0.01]减少及平均住院时间[(20.5±7.0)d与(31.4±8.1)d,t=-8.196,P<0.01]缩短. 结论 卒中单元模式下超早期康复治疗有利于脑出血患者的恢复.