Research On The Construction And Evaluation Of Hemorrhagic Stroke Clinical Pathway In Traditional Chinese Medicine

Purpose: To optimize the Traditional Chinese Medicine treatment plan of hemorrhagicstroke,which in order to“broken blood stasis and fill essence and marrow”as the core,tostructure the TCM clinical path of hemorrhagic stroke.To evaluate its feasibility from thehematoma absorption rate and neural function improvement degree using method ofcost-effectiveness analysis.In order to provide the clinical evidence for the superiority intreatment of hemorrhagic stroke and provide a basis to improve the clinical path ofhemorrhagic stroke in further.Method: Construct the preliminary clinical path in TCM of the hemorrhagic strokethrough review the medical record and seek advice from expert, optimize the originalhemorrhagic stroke treatment plan. Through clinical research, application of multi centercase-control study method. Select100cases of patients with hemorrhagic stroke, among them3cases out of clinical path,97qualified cases were completed; the clinical path group47cases and history control group50cases. Clinical pathway group were given oral Decoctionof Chinese herbal medicine (medicine composition: cattail pollen, leech, Tabanus, rhubarb,Shi Changpu, melon, tortoise plastron glue and so on), intravenous Xingnaojing injection,acupuncture, massage therapy in western medicine on the basis of the conventional treatment;The history control group were treated with conventional therapy. The standard length of stayof less than or equal to28days, We evaluate the NIHSS improvement on the day ofenrollment,1,2,3,4weeks or discharge and evaluate the hematoma volume on the day ofenrollment,2,4weeks or discharge. To evaluate the clinical efficacy by NIHSS improvementand hematoma absorption. Evaluation of health economics by cost-effectiveness analysisand incremental cost-effectiveness.Result:After the treatment by this scheme, two groups were effective. Clinical pathwaygroup compared with the history control group, after treatment for3weeks and4weeks ofclinical path group was better than the history control group on the degree of the NIHSSimproved and after treatment for2weeks of clinical path group is better than the historycontrol group (P <0.01) on the absorption of hematoma. The average days of hospitalizationof Clinical pathway group and history control group were20.30and22.71days, the Clinicalpathway group than the history control group2.41days less. Cost-effectiveness analysisrevealed the clinical pathway group compared with the history control group increase in thedirect costs, indirect costs and the total cost but no significant difference between two groups.The total cost of a downward trend after the inflation index adjusted. In the original cost, eachreceived1%of the efficient,1ml hematoma volume reduction and NIHSS score1point perimprove,the clinical pathway group of relatively less historical control group, respectively,12.82Yuan,152.72Yuan and533.11Yuan. The historical control group consumed and healthoutcomes are less than the cost of a clinical pathway group. According to the price indexadjustment of the original cost, each receive a1%efficient,1ml hematoma volume reductionand NIHSS score1point per improve, the clinical pathway group of relatively less historicalcontrol group, respectively,19.41Yuan and204.64Yuan and652.16Yuan. Compared withthe clinical pathway group, the control group each1%increase of efficient,1ml hematoma volume reduction and NIHSS score every improvement points, respectively, need more thanone cost13.48Yuan,70.86Yuan and99.11Yuan.Conclusion: The superior scheme is the TCM treatment plan of hemorrhagic stroke,which in order to“broken blood stasis and fill essence and marrow”as the core, which canimprove the clinical efficacy, shorten the average days of hospitalization, promote therecovery of neurological function, so that patients get more effective treatment while reducingthe economic costs.