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目的:观察中西医结合卒中单元与普通病房对改善脑卒中后肩手综合征患者的效果,并从卫生经济学角度对两者进行成本-效果分析。方法:将200例患者随机分为治疗组(中西医结合卒中单元组)和对照组(普通病房组),各100例。治疗组采用规范的中西医结合卒中小组管理模式;对照组采用与治疗组相似的治疗方法,但缺乏个体化,治疗模式不统一。比较2组患者治疗1月后的临床效果(肢体运动功能、肩关节功能、肩部水肿情况和日常生活活动能力等)和成本分析(包括总住院日、住院医药费、病人工资损失、陪护者工资损失、总费用等);统计2组治疗1月的临床效果。结果:治疗后1、3、6月,2组Fuglmeyer量表上肢部分(FMA-UE)评分、Constant-Murley肩功能评分、改良Barthel指数(MBI)评分均较治疗前升高(P<0.05),水肿评分较治疗前降低,且治疗组上述各时段评分改善均较对照组显著(P<0.05)。总有效率治疗组为92.0%,对照组为82.0%,2组比较,差异有统计学意义(P<0.05)。成本-效果分析,2组间总费用差异无统计学意义(P>0.05)。结论:中西医结合卒中单元治疗脑卒中后肩手综合征具有较好的临床效果,而且医疗成本并没有增加。
Objective: To observe the effect of combining traditional Chinese and western medicine stroke units and general ward on the improvement of shoulder-hand syndrome patients after stroke, and to carry out the cost-effectiveness analysis of both from the perspective of health economics. Methods: 200 patients were randomly divided into treatment group (combination of Chinese and Western Stroke Unit) and control group (general ward group), each 100 cases. The treatment group adopted the standardized TCM-WM combined stroke group management model; the control group adopted the similar treatment group as the treatment group, but lack of individualization and the treatment model was not uniform. The clinical effects (limb motor function, shoulder joint function, shoulder edema and activities of daily living, etc.) and cost analysis (including total hospital stay, hospitalization expenses, loss of patient’s salaries, Wage loss, total cost, etc.); The clinical effect of two groups of treatment in January was statistically analyzed. Results: At 1, 3 and 6 months after treatment, the FMA-UE score, Constant-Murley shoulder function score and Modified Barthel Index (MBI) scores of two Fuglmeyer scales were significantly higher than those before treatment (P <0.05) , The score of edema was lower than that of before treatment, and the improvement of score in each time period of the treatment group was more significant than that of the control group (P <0.05). The total effective rate was 92.0% in the treatment group and 82.0% in the control group. There was significant difference between the two groups (P <0.05). Cost-effectiveness analysis showed no significant difference between the two groups (P> 0.05). Conclusion: The TCM-WM combined stroke unit has good clinical effect in treating shoulder-hand syndrome after stroke, and the medical cost has not increased.