临床路径在食管癌放化疗中的应用

Clinical application of a clinical pathway for chemoradiation with esophageal carcinoma

目的评价临床路径在食管癌放化疗中的实施效果。方法采用非同期队列研究比较实施临床路径前与实施临床路径后两组患者的相关情况。路径共三个，评价指标包括：①治疗适应症；②放疗方式；③放疗剂量；④顺应性；⑤放化疗反应。结果研究组治疗适应症把握严格，治疗相对规范；放疗方式中常规放疗占42％，常规＋适形占17％，全程适形占41％；剂量50～60Gy，平均为52．3Gy；顺应性较好；放化疗反应血象和放射性食管炎与对照组相似（Х^2=1．22，P〉0．05和Х^2=0．589，P〉0．05），但放疗后气促较对照组明显降低（Х^2=8．241，P〈0．05），差异有显著性意义。对照组治疗适应症把握不严，治疗欠规范；放疗方式中常规放疗占85％，常规＋适形占6％，全程适形占9％；放疗剂量随意性较大，46～70Gy，平均为67．5Gy；顺应性差。结论实施食管癌临床路径能够规范治疗，降低毒副作用，提高医疗质量，值得临床进一步推广应用。

Objective To evaluate the effects of the clinical pathway for esophageal carcinoma and provide evidences for further improving the pathway.Methods Prospective cohort study was applied to compare the status between the previous group and the clinical pathway group, for whom the clinical pathway was applied.Evaluation indicators including： ①indication, ②radiation mode, ③radiation dose, ④compliance, ⑤ response of radiotherapy and chemotherapy.Results The indications was more stricted and treatment was relatively standardized in the study group than those in the contrast group. The percent of normal radiation in the study group was 42%, normal radiation plus comformal radiation 17%, fully comformal radiation 47% .radiation dose was from 50 to 60 Gy, and the average dose was 52.3 Gy. The compliance was better in the study group than those in the contrast group. There were no significant difference of radiation response and esophagitis in two groups（ Х^2 = 1.22, P〉 0. 05 ; Х^2 = 0.589, P 〉 0.05）.Shortness of breath on postradiation could be evidencely reduced in the study group, and there were statistical difference between two groups（Х^2=8.241, P 〈 0.05）. The percent of normal radiation in the contrast group was 85%, normal radiation plus comformal radiation 6%, fully comformal radiation 9% .radiation dose was from 46 to 70 Gy, and the average dose was 67.5Gy.Conclusion The application of clinical pathway on patients with esophageal carcinoma can improve the quality of medical care, and it deserves to be used more widely.