目的 对脑瘫患儿医院康复与医院-家庭康复模式进行成本-效果分析。方法 2016年1月至12月,将本院60例1~3岁的脑瘫患儿分为医院康复组和医院-家庭康复组,每组各30例。医院康复组给予本科规范的中西医结合康复治疗(运动疗法、物理因子疗法和中医综合疗法),医院-家庭康复组由医院提供专业技术培训、指导和对患儿进行专业评估,家长实际操作。分别于治疗前、治疗结束时采用粗大运动功能测试(GMFM)和Peabody精细运动发育量表(PDMS-FM)评价患儿粗大运动功能和精细运动功能。结果 治疗结束时,与医院-家庭康复组比较,医院康复组GMFM评分显著改善(t=5.333, P<0.001),总医疗成本显著增高(t=23.614, P<0.001),但GMFM和PDMS-FM视觉-运动整合评分每增加1分所支出的医疗费用降低(t>2.065, P<0.05)。结论 医院康复模式对小年龄脑瘫儿童可能是更为经济、有效的治疗方案,医院-家庭康复模式可以作为此年龄段的有效补充康复模式。

Objective To analyze the cost-effectiveness of hospital rehabilitation and hospital-family rehabilitation in children with cerebral palsy.Methods From January to December, 2016, 60 cases of children aged one to three years with cerebral palsy were divided into hospital rehabilitation group and hospital-family rehabilitation group, with 30 cases in each group. The hospital rehabilitation group received rehabilitation of traditional Chinese and Western medicine treatment, including exercise therapy, physical therapy and Chinese Medical therapy; while the hospital-family rehabilitation group received family rehabilitation. The Gross Motor Function Measure (GMFM) and Peabody Developmental Motor Scale-fine Motor (PDMS-FM) were used to evaluate the motor function and fine motor function before and after treatment.Results The GMFM score was higher (t=5.333, P<0.001), and the total medical cost was higher (t=23.614, P<0.001) in the hospital rehabilitation group than in the hospital-family rehabilitation group. However, the cost of medical care was significantly lower for every 1-point increase in GMFM and visual-motion integration of PDMS-FM in the hospital rehabilitation group than in the hospital-family rehabilitation group (t>2.065, P<0.05).Conclusion The hospital rehabilitation model may be a more economical and effective treatment for younger age children with cerebral palsy, and the hospital-family rehabilitation model could be used as an effective complementary rehabilitation model for this age group.