重症医学科重度子痫前期产妇围手术期临床路径的应用

The application of perioperative clinical pathway for severe preeclampsia patients in intensive care unit

目的评价综合重症医学科（ICU）开展重度子痫前期产妇围手术期临床路径（CP）的效果，并分析其变异情况以促进质量改进。方法比较福建医科大学附属第二医院ICU内实行CP前1年（2009年1月至12月，14例）和实施CP后1年（2010年1月至12月，22例）收治的重度子痫前期产妇ICU停留时间、住院费用、并发症发生率、病死率以及术后前3d血压控制的总有效率。结果与实施CP前1年组比较，实施CP后1年组IcU停留时间（h）明显缩短（65．5±24．9比86．3±28．2，t=2．321，P〈0．05），ICU住院费用（元）明显减少（6463．6±1838．2比8136．5±2142．8，t=2．496，P〈0．05），并发症发生率有所下降（36．4％比42．8％，x2=0．100，P〉0．05）；血压控制的总有效率术后1d、2d明显提高（1d：59．1％比14．3％，2d：86．4％比50．0％，均P〈0．05），而术后3d则无明显差异（95．4％比85．7％，P〉0．05）。实施CP前1年组死亡1例，实施CP后1年组无死亡。结论通过对重度子痫前期产妇围手术期实施CP管理，降低了患者的医疗负担，促进了医疗质量持续改进。

Objective To evaluate the effect of implementation of perioperative clinical pathway （CP） for severe preeelampsia patients in intensive care unit （ICU）, and to discuss variation factors in order to improve clinical quality. Methods Thirty-six patients treated in ICU in the Second Clinical Hospital of Fujian Medical University were divided into two groups according to time of 1 year before implementation of CP （from January to December in 2009, n= 14） and 1 year after implementation of CP （from January to December in 2010, n = 22）. The length of stay in ICU, cost of hospitalization, occurrence of major complications and mortality, as well as the total effective rate of control of blood pressure in the first 3 clays after operation were compared. Results Compared with the group of patients of 1 year before implementation of CP, in the group of patients of 1 year after implementation of CP, the length of stay in ICU （hours） was significantly shorter （65.5±24.9 vs. 86.3±28.2, t=2.321, P±0.05）, the cost of hospitalization （yuan） was significantly lower （6 463.6 ± 1 838.2 vs. 8 136.5 ± 2 142.8, t = 2. 496, P〈 0. 05）, the occurrence rate of major complications was lower （36.4% vs. 42.8%, X2=0. 100, P〉0. 05）, the total effective control rate of blood pressure was significant improved on the 1st and the 2nd postoperative day （1 day： 59.1 % vs. 14.3%, 2 days： 86.4% vs. 50.0%0, both P〈0. 05）, but there was no significant change on the 3rd postoperative day （95.4% vs. 85.7%, P〉0.05）. One patient died before the application of CP, and none after its application. Conclusion These results suggested that it was beneficial to implement the program in preeclampsia patients to improve medical quality.