首发和复发抑郁障碍临床路径管理的效果研究

Study on the effect of clinical pathway management in first episode depressive disorder and recurrent depressive disorder

目的：探讨临床路径管理对首发抑郁障碍和复发抑郁障碍患者的效果。方法采用临床随机对照试验的方式，将2012年11月至2013年12月山西医科大学第一医院收治的首发抑郁障碍患者98例和复发抑郁障碍患者124例随机分为试验组（临床路径管理组）和对照组（常规管理组），进行临床观察。结果首发抑郁障碍患者实施临床路径管理的住院费用和住院天数均低于常规管理的患者（t=3.441，P=0.001；t=2.959，P=0.004），其实施临床路径管理的总有效率91.84%高于常规管理组的总有效率75.51%（χ2=4.781，P=0.029）；复发抑郁障碍实施临床路径管理的患者住院费用和住院天数也低于常规管理组（t=2.149，P=0.033；t=2.424，P=0.017），其实施临床路径管理的总有效率88.71%高于常规管理组的总有效率74.19%（χ2=4.324，P=0.038）；实施临床路径管理的首发抑郁患者住院费用低于复发抑郁患者的住院费用（t=7.897，P<0.01），而住院天数和临床疗效两组差异无统计学意义（P>0.05）。结论临床路径管理无论对首发抑郁障碍还是复发抑郁障碍患者均可降低其住院费用，缩短住院天数，提高临床疗效。

Objective Toinvestigatetheeffectofclinicalpathwaymanagementinfirstepisodedepressive disorder and recurrent depressive disorder. Methods Using the clinical randomized controlled trial mode, From November 2012 to December 2013, There were 98 patients with first episode depressive disorder and 124 patients with recurrent depressive disorder in the First Hospital of Shanxi Medical University. Those patients were respectively randomly divided into the experimental group (clinical pathway management) and the control group (conventional management). The clinical effect was observed. Results Hospitalization expenses and hospitalization days of first episode depressive disorder patients using clinical pathway management were lower than patients using conventional management(t=3.441, P=0.001;t=2.959, P=0.004).The total effective rate of first episode depressive disorder patients using clinical pathway management was 91.84%, higher than the conventional management group that was 75.51%(χ2=4.781, P=0.029). Hospitalization expenses and hospitalization days of recurrent depressive disorder patients using clinical pathway management were lower than patients using conventional management too(t=2.149, P=0.033;t=2.424, P<0.017). Its'' clinical effect was higher than the conventional management group(χ2=4.324, P=0.038). Hospitalization expenses of first episode patients using clinical pathway management were lower than patients with recurrent depression disorder(t=7.897, P<0.01),hospitalization days and total effective rate had no significant difference (P>0.05). Conclusion Clinical pathway management can reduce the hospitalization days and expenses, then improve the clinical effect in both of the patients with first episode depressive disorder and recurrent depressive disorder.