胆囊结石合并内科疾病患者门诊早期干预临床路径的研究

Study of early intervention clinic pathway that cholecystolithiasis complicated with medical disease examined through outpatient clinic health cxamination

目的探讨建立门诊早期干预临床路径,对门诊健康体检发现合并有高血压、糖尿病等内科疾病的胆囊结石患者,进行标准化处理,使其能够在入院时直接进入胆囊切除临床路径的可行性。方法对本院门诊健康体检中心筛选出的80例胆囊结石合并有高血压、糖尿病的患者(门诊处理组,n=80),按照门诊早期干预临床路径的要求,采用门诊随访的方式,控制血压、血糖至正常范围,然后收入住院,按照胆囊临床路径实施标准化处理。对照同期130例住院后术前检查发现合并内科疾病,经内科治疗控制症状后行腹腔镜胆囊切除术患者(住院处理组,n=130),比较两组之间平均住院时间和住院费用的差别。结果门诊处理组的住院时间、住院费用明显少于住院处理组。结论通过门诊健康体检,及早发现有内科合并症患者,按照标准化程序对其在入院前实施干预,待症状控制后再入院进入临床路径,可以减少患者入院时间,节约住院费用。

Objective To discuss a feasibility of a clinic pathway（CP） ,that cholecystolithiasis patients complicated with medical disease.such as hypertension and diabetes-mellitus, examined through outpatient clinic（OPC） health examination and received standard treatment,could enter the cholecystectomy clinic pathway directly when they are admission. Methods 80 cholecystolithiasis outpatients（Outpatient Group, n= 80） who complicated with hypertension and diabetes-mellitus that examined through OPC health examination, entered the cholecystectomy CP and had a selective laparoscopic cholecystectomy（LC）, after they controled their blood pressure（BP） and blood glucose（BG） in normal range by outpatient clinic treatment. 130 inpatients（Inpatient Group, n= 130） complicated with hypertension and diabetes mellitus found in preopertive examination,received a LC after medical treatment inpatient. To compare the average stay and cost of the outpatient group with that of inpatient group. Results The average stay and cost of outptient group was obviously less than of inpatient group. Conclusion Through CPO health examination, patients complicate with morbus internus can be found as early as possible,and receive standard treatment. After they control their symptoms,they can enter the CP. That can decrease average stay and save money.