论文部分内容阅读
目的应用卒中预后特异和非特异评估体系以及卫生经济学评估体系,评价急性缺血性卒中血管内治疗的临床效果与效率。方法选择首都医科大学附属北京天坛医院于2015年1-4月收治的符合急性缺血性卒中血管内治疗的患者,分为血管内治疗组和对照组,评价指标包括:(1)特异性指标:入院后14 d神经功能缺损程度卒中量表(National Institute of Health Stroke Scale,NIHSS)评分,90 d后改良Rankin量表(modified Rankin Scale,m RS)评级,90 d及1年内卒中发生率;(2)非特异指标:1年内院内感染、急性心肌梗死、症状性脑出血的发生率;(3)卫生经济学指标:患者1年医疗总费用、总药费,1年内住院次数及累计住院日、累计重症监护病房(Intensive Care Unit,ICU)住院日。结果急性缺血性卒中患者给予血管内治疗预后较对照组在入院后14 d NIHSS评分采用秩和检验比较,血管内治疗组明显优于对照组(P<0.01);90 d及1年内卒中发生率采用χ2检验,发现血管内治疗组的90 d卒中再发率(P<0.05)及1年内卒中再发率(P<0.01)均低于对照组。与对照组相比,血管内治疗组患者1年内院内感染、急性心肌梗死、症状性脑出血采用χ2检验,两组间差异无显著性。入院后90 d m RS评级采用秩和检验,对照组无残疾或轻度(0~1级)、中度(2~3级)、重度残疾(4~5级)及死亡人数分别为3例、15例、23例和4例,血管内治疗组分别为17例、12例、3例和5例,血管内治疗组较对照组明显改善(P<0.05)。血管内治疗组在1年内累计医疗花费与对照组比较,差异无显著性,但在1年内住院次数(P<0.01)、药费(P<0.05)以及ICU住院日(P<0.01)较对照组明显下降。结论急性缺血性卒中患者的血管内治疗可以提高患者的预后,在提高医疗质量的同时并没有增加患者的住院费用,可以减少患者的住院次数及药费。
Objective To evaluate the clinical effect and efficiency of endovascular treatment of acute ischemic stroke by using the specific and non-specific evaluation system of stroke prognosis and the evaluation system of health economics. Methods The patients eligible for endovascular treatment of acute ischemic stroke admitted to Beijing Tiantan Hospital, Capital Medical University from January to April, 2015 were divided into the endovascular treatment group and the control group. The evaluation indexes included: (1) Specificity : National Institute of Health Stroke Scale (NIHSS) score 14 days after admission, modified Rankin Scale (m RS) 90 days after stroke, incidence of stroke at 90 days and 1 year; (2) non-specific indicators: 1-year nosocomial infection, acute myocardial infarction, the incidence of symptomatic cerebral hemorrhage; (3) health economics indicators: 1 year patient total medical costs, total drug costs, 1 year hospitalization and cumulative hospitalization Day, cumulative Intensive Care Unit (ICU) hospitalization days. Results The prognosis of endovascular treatment of patients with acute ischemic stroke was higher than that of control group on the 14th day after admission, and the rank sum test was used to compare the NIHSS score in the endovascular treatment group and the control group (P <0.01) Rates using χ2 test found that 90-day stroke recurrence rate (P <0.05) and 1-year stroke recurrence rate (P <0.01) were lower in the endovascular treatment group than in the control group. Compared with the control group, 1-year nosocomial infection, acute myocardial infarction, and symptomatic intracerebral hemorrhage in patients in the endovascular group were significantly higher than those in the control group (χ2 test). There was no significant difference between the two groups. At 90 days after admission, RS ratings were tested by rank sum test. There was no disability or mild grade 0 to 1, moderate grade 2 to 3, severe disability 4 to 5, and 3 deaths in the control group. 15 cases, 23 cases and 4 cases. The endovascular treatment group was 17 cases, 12 cases, 3 cases and 5 cases. The endovascular treatment group was significantly improved compared with the control group (P <0.05). Compared with the control group, the cumulative medical expenses in the endovascular group were not significantly different from those in the control group within one year, but the number of inpatients (P <0.01), the drug cost (P <0.05) and the ICU stay (P <0.01) Group decreased significantly. Conclusion Endovascular treatment of acute ischemic stroke patients can improve the prognosis of patients, improve the quality of medical care without increasing the cost of hospitalization, reduce the number of hospitalizations and drug costs.