CAJ | 학술논문

目的评价临床路径管理对不同急性卒中治疗低分子肝素试验(TOAST)亚型急性脑梗死(ACI)的效果.方法根据本院特点制定ACI 临床路径,将1036例连续收住入院、发病在3d内的ACI患者纳入研究,采用非同期队列研究对比未实施临床路径组472例(非路径组)与临床路径组564例(临床路径组)不同TOAST亚型ACI患者平均住院日、平均总费用、平均药费、平均检查费和预后良好率,预后良好率以出院90d时改良Rankin评分(mRS)为0～2分的比率评价.结果与非路径组相比,临床路径组患者平均住院日缩短[(13.2±5.3)d比(16.1±9.7)d,P=0.004],预后良好比率升高(71.1％比62.1％,P=0.002)；大动脉粥样硬化型脑梗死平均住院日缩短(P =0.000),平均费用、平均药费降低(P分别为0.044、0.036),预后良好率升高(P=0.002)；而小动脉闭塞型、心源性栓塞型、其他明确病因型和不明原因型各项指标均差异无统计学意义.结论临床路径管理可使得ACI患者获益,大动脉粥样硬化型获益较其他四型更为显著.
목적 평개림상로경관리대불동급성졸중치료저분자간소시험(TOAST)아형급성뇌경사(ACI)적효과.방법 근거본원특점제정ACI 림상로경,장1036례련속수주입원、발병재3d내적ACI환자납입연구,채용비동기대렬연구대비미실시림상로경조472례(비로경조)여림상로경조564례(림상로경조)불동TOAST아형ACI환자평균주원일、평균총비용、평균약비、평균검사비화예후량호솔,예후량호솔이출원90d시개량Rankin평분(mRS)위0～2분적비솔평개.결과 여비로경조상비,림상로경조환자평균주원일축단[(13.2±5.3)d비(16.1±9.7)d,P=0.004],예후량호비솔승고(71.1％비62.1％,P=0.002)；대동맥죽양경화형뇌경사평균주원일축단(P =0.000),평균비용、평균약비강저(P분별위0.044、0.036),예후량호솔승고(P=0.002)；이소동맥폐새형、심원성전새형、기타명학병인형화불명원인형각항지표균차이무통계학의의.결론 림상로경관리가사득ACI환자획익,대동맥죽양경화형획익교기타사형경위현저.
Objective To evaluate the cost-effectiveness of clinical pathway for different Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes of patients with acute cerebral infarction (ACI).Methods ACI clinical pathway was developed according to the characteristics of our hospital.A total of 1036 ACI patients were recruited.They were divided into control (n =472) and pathway (n =564) groups.The hospitalization time,hospitalization expenses and clinical outcomes between two groups of different TOAST subtypes were compared.Good clinical outcome was defined as a modified Rankin Score (mRS) of 0-2.Results Compared to control group,the lengths of stay for ACI patients in pathway group were significantly shorter (P =0.004) while those with good clinical outcomes were significantly higher (P =0.002).Furthermore,the lengths of stay for large artery atherosclerosis (LAA) subtype patients in pathway group were shorter (P =0.000),both total hospital charges and medication costs were significantly reduced (P =0.044,0.036) while those with good clinical outcome were significantly higher (P =0.002); the differences among other four subtypes of small artery occlusion (SAO),cardioembolism (CE),stroke of other etiology (SOE) and stroke of undetermined etiology (SUE) were not statistically significant.Conclusion The implementation of clinical pathway may offer more benefits to LAA subtype ACI patients than other subtypes.