急性缺血性卒中血管内治疗的临床效果与效率评价

摘要/Abstract

摘要：

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，mRS）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 N IHSS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χ 2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χ 2检验，两组间差异无显著性。入院后90 d mRS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I CU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。

文章导读： 本研究为对照研究，通过采用卒中特异和非特异评估体系以及卫生经济学评估体系，明确了急性缺血性卒中患者，采取机械取栓治疗后的临床效果与效率，为更新国家医疗管理及医疗保险相关政策的理论依据。

关键词: 卒中; 血管内治疗; 效果评价

Abstract:

Objective To evaluate the clinical effect and efficiency of endovascular treatment of acute ischemic stroke through utilization of stroke prognosis specific and non-specific as well as health economics evaluation system. Methods Patients who were eligible for acute ischemic stroke endovascular treatment and admitted to Beijing Tiantan Hospital, Capital Medical University from January to April in 2015 were divided into the endovascular treatment group and control group. The main criteria for evaluation were: ①Specific indicators: 14 days National Institute of Health Stroke Scale (NIHSS) score after admission, 90 days after the modified Rankin scale (mRS) rating, 90 days and 1 year of stroke incidence; ②Non-specific indicators: 1 year incidence of nosocomial infection, acute myocardial infarction and symptomatic intracerebral hemorrhage; ③Health economics indicators: 1 year total health care costs, the total cost of drugs, hospital days in hospital cumulative intensive care unit

(ICU) length of stay. Results The endovascular treatment group had a better prognosis than the control group at 14 days NIHSS score after admission (P <0.01); 90 days (P <0.01) and one year (P <0.05) incidence of stroke (by χ 2 test) were both lower than the control group. There was no difference in the incidence of 1 year nosocomial infections, acute myocardial infarction and symptomatic intracerebral hemorrhage rate by χ 2 test. The 90 d mRS rating used rank sum test. The number of no disability or mild disability (grade 0-1), moderate disability (grade 2-3), severe disability (grade 4-5) and death of the control group and endovascular treatment group were 3 vs 17, 15 vs 12, 23 vs 3, 4 vs 5, respectively. And there was no difference in the 1 year cost with the control group. Compared with the control group, the endovascular treatment group decreased significantly in the number of hospitalizations per year (P <0.01), medicine (P <0.05) and ICU length of stay (P <0.01). Conclusion Endovascular treatment for acute ischemic stroke patients can improve the prognosis of patients, improving quality of care at the same time. It doesn’t increase the expense of hospitalization and can reduce the cost for patient's hospitalization and medication.

Key words: Stroke; Endovascular treatment; Effect evaluation

邓一鸣，霍晓川，高峰，莫大鹏，马宁，孙瑄，宋立刚，王伊龙，王拥军，赵性泉，缪中荣. 急性缺血性卒中血管内治疗的临床效果与效率评价[J]. 中国卒中杂志, 2016, 11(10): 829-835.

DENG Yi-Ming, HUO Xiao-Chuan, GAO Feng, et al.. The Evaluation of Clinical Effect and Efficiency of Endovascular Treatment for Acute Ischemic Stroke Treatment[J]. Chinese Journal of Stroke, 2016, 11(10): 829-835.

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