优化创伤性血气胸临床路径的探索

An exploration on clinical pathway optimization for posttraumatic hemopneumothorax

目的基于急诊科与胸外科密切协作,探索更加高效、节约和安全的创伤性血气胸临床路径。方法以该院急诊科接诊的创伤性血气胸病例62例为研究对象,按就诊日期分为两组,传统路径组(30例)明确诊断后交由胸外科专科治疗,协作路径组(32例)明确诊断后与胸外科密切协作在急诊科进行救治,需剖胸手术者才转入胸外科治疗,所有病例随访2个月,比较两组患者的性别构成、年龄分布、创伤严重程度、主要治疗手段、治疗效果、并发症、平均住院日、人均医疗费用等情况。结果 2种临床路径病例的性别构成、年龄分布、创伤严重程度、主要治疗手段、治疗效果及并发症等方面比较差异均无统计学意义(P>0.05);协作路径组患者平均住院日和人均医疗费用显著低于传统路径组(P<0.05)。结论对于创伤性血气胸患者,急诊科与胸外科密切协作的临床路径与传统临床路径相比,同样安全并且更加节约高效。

Objective To explore a safe,more efficient and more saving clinical pathway for the patients with posttraumatic hemopneumothorax based on closer collaboration between emergency department and thoracic surgery department.Methods All patients with posttraumatic hemopneumothorax were diagnosed in emergency department,and divided randomly into 2 groups.The control group（n=30）was delivered to thoracic surgery department for treatment,while the study group（n=32）was treated in emergency department,only if some of them were found to need thoracotomy,they were delivered to thoracic surgery department for operation.All patients were followed up for 2 months.Then indicators including gender composition,age distribution,traumatic severity,main treatment methods,curative effects,complications,average length of stay and costs were collected and compared.Results There was no significant difference between the two groups in gender composition,age distribution,traumatic severity,main treatment methods,curative effects,or complications.However,the average length of stay and costs in the study group were significantly lower than those in the control group（P0.05）.Conclusion For those patients with posttraumatic hemopneumothorax,the clinical pathway with active participation of emergency department is safe,more efficient and more saving than handled by thoracic surgery department alone.