本文選題：臨床路徑　切入點(diǎn)：腦卒中　出處：《南京醫(yī)科大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：目的：分別從臨床功能和衛(wèi)生經(jīng)濟(jì)學(xué)角度評估缺血性腦卒中早期康復(fù)臨床路徑聯(lián)合康復(fù)方案的效果,為腦卒中早期康復(fù)臨床路徑的優(yōu)化和推廣提供數(shù)據(jù)支持。方法：采用隨機(jī)、單盲、平行對照、多中心的前瞻性研究,符合納入標(biāo)準(zhǔn)的缺血性腦卒中患者286例,隨機(jī)分為臨床路徑組(n=143)和常規(guī)康復(fù)組(n=143)。臨床路徑組入組后進(jìn)入腦卒中早期康復(fù)臨床路徑及相應(yīng)的康復(fù)治療方案,常規(guī)康復(fù)組采取一般康復(fù)治療,不進(jìn)入臨床路徑,對康復(fù)治療內(nèi)容及時間不做要求。分別于入組前和臨床路徑介入后第三周末(即出院時)采用主要結(jié)局指標(biāo)改良Barthel指數(shù)(Modified Barthel Index, MBI)以及次要結(jié)局指標(biāo)腦卒中ICF核心分類組合簡版、簡化Fugl-Meyer運(yùn)動功能評分量表(Fugl-Meyer Motor Assessment Scale, FMA)、Gugging吞咽功能評估(Gugging Swallowing Screen, GUSS)對兩組患者的日�；顒幽芰Α⒕C合功能水平、運(yùn)動功能、吞咽功能進(jìn)行評定和分析。并采用成本-效果分析、增量分析評價兩組患者的衛(wèi)生經(jīng)濟(jì)學(xué)指標(biāo)。結(jié)果：(1)259例患者納入統(tǒng)計,其中臨床路徑組136例,男性90例,女性46例,常規(guī)康復(fù)組123例,男性91例,女性32例。(2)臨床路徑組康復(fù)治療前后的MBI差值(MBI1-MBI0)、MBI改善程度((MBI1-MBIo) /(100-MBI0)×100%)均顯著高于常規(guī)康復(fù)組,差異有統(tǒng)計學(xué)意義(P0.05)。(3)臨床路徑組康復(fù)治療前后腦卒中ICF核心分類組合簡版總分差值高于常規(guī)康復(fù)組,差異有統(tǒng)計學(xué)意義(P0.05)。(4)兩組患者康復(fù)治療前后FMA差值(FMA1-FMA0)及FMA改善程度((FMA1-FMA0)/(100-FMAo)×100%)比較差異無統(tǒng)計學(xué)意義(P0.05)。(5)71例患者伴有吞咽障礙,臨床路徑組(n=39)患者康復(fù)治療前后GUSS差值高于常規(guī)康復(fù)組(n=32),差異有統(tǒng)計學(xué)意義(P0.05)。(6)臨床路徑組日�；顒幽芰BI每提高1分,住院總費(fèi)用(889.92元)及康復(fù)費(fèi)用(344.72元)均低于常規(guī)康復(fù)組(1161.22和685.68元)；增量分析表明臨床路徑組MBI每多提高1分,需額外花費(fèi)的住院總費(fèi)用和康復(fù)費(fèi)用分別是196.73和95.50元。敏感度分析也表明臨床路徑組MBI每提高1分的花費(fèi)比常規(guī)康復(fù)組少。結(jié)論：早期康復(fù)臨床路徑結(jié)合規(guī)范化的康復(fù)方案能提高缺血性腦卒中患者的日常活動能力,改善患者的功能,并能提高住院康復(fù)費(fèi)用的利用效率,節(jié)約康復(fù)資源。
[Abstract]:Objective: to evaluate the effect of combined rehabilitation regimen in early rehabilitation of ischemic stroke from the point of view of clinical function and health economics, and to provide data support for optimizing and popularizing the clinical pathway of early rehabilitation of cerebral apoplexy. A single blind, parallel controlled, multicenter prospective study of 286 patients with ischemic stroke that met the inclusion criteria, The patients were randomly divided into two groups: the clinical pathway group and the routine rehabilitation group. The clinical pathway group entered into the early stage of stroke rehabilitation clinical pathway and the corresponding rehabilitation treatment plan. The routine rehabilitation group received general rehabilitation treatment, but did not enter the clinical path. The content and time of rehabilitation treatment were not required. The main outcome index, modified Barthel index (MBI), and the ICF core classification combination of secondary outcome index of stroke were adopted before entering group and at the end of the third week after clinical pathway intervention (i.e. when discharged from hospital). The simplified Fugl-Meyer motor function scale was used to evaluate and analyze the daily activity ability, comprehensive functional level, motor function and swallowing function of the two groups by using the Fugl-Meyer Motor Assessment scale, FMA-Gugling swallowing function to evaluate and analyze the daily activity ability, comprehensive functional level, motor function and swallowing function of the two groups, and cost-effect analysis was used to evaluate and analyze the daily activity ability, comprehensive functional level, motor function and swallowing function of the two groups. Results there were 136 cases in the clinical pathway group, 90 cases in the male group, 46 cases in the female group, 123 cases in the routine rehabilitation group, 91 cases in the male group, and there were 136 cases in the clinical pathway group, 90 cases in the male group, 46 cases in the female group, 123 cases in the routine rehabilitation group and 91 cases in the male group. The difference of MBI before and after rehabilitation treatment in 32 female patients with clinical pathway group was significantly higher than that in the routine rehabilitation group, and the improvement degree of MBI1-MBIo- / 100-MBI0) was significantly higher than that in the conventional rehabilitation group. The difference of total score of ICF core classification combination before and after rehabilitation in the clinical pathway group was higher than that in the routine rehabilitation group. There was no significant difference in the difference of FMA between the two groups before and after rehabilitation treatment (FMA1-FMA0) and the degree of improvement of FMA (FMA1-FMAO / 100-FMAo100) 脳 100). There was no significant difference between the two groups (P0. 05%, P 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05). The difference of GUSS before and after rehabilitation in the clinical pathway group was higher than that in the routine rehabilitation group, and the difference was statistically significant (P < 0.05). The difference was significant (P < 0.05). The daily activity ability (MBI) of the clinical pathway group was increased by 1 point. The total cost of hospitalization (889.92 yuan) and the cost of rehabilitation (344.72 yuan) were lower than that of routine rehabilitation group (1161.22 and 685.68 yuan). The total hospitalization cost and rehabilitation cost were 196.73 and 95.50 yuan respectively. Sensitivity analysis also showed that the cost of each increase of MBI in the clinical pathway group was less than that in the routine rehabilitation group. Conclusion: the clinical pathway of early rehabilitation combined with standardization is less than that of the routine rehabilitation group. The rehabilitation program can improve the daily activity ability of patients with ischemic stroke. It can improve the function of patients, improve the utilization efficiency of hospitalization rehabilitation costs, and save rehabilitation resources.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R743.3

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