通讯作者: 蔡亚梅

DOI：10.12201/bmr.202511.00005

Evaluation of the implementation effect of TCM clinical pathway optimization scheme for acute ischemic stroke with wind-phlegm stasisZhang Peng, SHEN Yueling, CAI Yame

• 摘要：目的 评价中医临床路径优化方案治疗风痰瘀血证急性缺血性卒中的临床价值。方法 采用随机对照试验设计，纳入240例患者，分为路径组（n=120）与对照组（n=120）。对照组采用常规西医治疗；路径组在对照组基础上联合中医临床路径干预。比较两组住院时间、住院费用、中医症状积分、NIHSS评分、Barthel指数及患者满意度。结果 ①疗效方面：路径组总有效率为99.2%（对照组97.5%，P＜0.001），中医症状积分下降幅度66.7%（对照组为42.9%）；②功能改善：路径组NIHSS评分及Barthel指数均优于对照组（均P＜0.001）；③经济性：路径组住院天数中位数为12天（对照组为14天，P＜0.001），总费用中位数降低28.3%（11899.76元 vs 16580.46元），其中西药费下降41.9%（净节省1013.71元/人），中药费用占比15.5%，检查及化验费用分别下降34.5%与52.2%；④患者体验：路径组满意度评分显著提高（P＜0.001）；⑤安全性：240例患者完成全程监测，未出现药物相关严重不良反应，实验室指标异常率为1.3%（3/240）。结论 中医临床路径整合彝族医药复方、动态辨证与结构化非药物疗法，可显著提高疗效、优化医疗资源配置，为风痰瘀血证卒中提供循证医学支持，符合国家中医药发展战略。

  关键词： 急性缺血性卒中；风痰瘀血证；中医临床路径；疗效; ; ; 

   

  Abstract: Objective To evaluate the clinical value of an optimized Traditional Chinese Medicine (TCM) clinical pathway in treating acute ischemic stroke with wind-phlegm-stasis syndrome. Methods A randomized controlled trial included 240 patients, assigned to a pathway group (n=120) and a control group (n=120). The control group received conventional Western medicine treatment, while the pathway group received additional TCM clinical pathway interventions. Outcomes included length of hospital stay, costs, TCM symptom scores, NIHSS scores, Barthel index, and patient satisfaction. Results ① Efficacy: The total effective rate was 99.2% in the pathway group versus 97.5% in the control group (P＜0.001). TCM symptom scores decreased by 66.7% in the pathway group and 42.9% in the control group (P＜0.001). ② Functional improvement: NIHSS scores and Barthel index were superior in the pathway group (all P＜0.001). ③ Economic outcomes: Median hospital stay was 12 days in the pathway group (14 days in controls, P＜0.001), with a 28.3% reduction in total costs (11899.76 yuan vs 16580.46 yuan). Western medicine costs decreased by 41.9% (net saving 1013.71 yuan per patient), while TCM costs accounted for 15.5% of total expenses. Examination and laboratory costs decreased by 34.5% and 52.2%, respectively. ④ Patient satisfaction was significantly higher in the pathway group (P＜0.001). ⑤ Safety: No serious adverse drug reactions occurred; laboratory abnormality rate was 1.3% (3/240).Conclusion The integrated TCM clinical pathway, incorporating Yi medicine compounds, dynamic syndrome differentiation, and structured non-pharmacological therapies, significantly improves outcomes and optimizes resource allocation, providing evidence-based support for stroke management aligned with national TCM development strategies.

  Key words: Acute ischemic stroke; Wind-phlegm stasis syndrome; TCM clinical pathway; Efficacy evaluation

  提交时间：2025-11-04

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• 序号	提交日期	编号	操作
  1	2025-10-12	10.12201/bmr.202511.00005V1	下载

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