慢性阻塞性肺疾病临床路径实施细化探讨

Special considerations in implementation of clinical pathway of chronic obstructive pulmonary disease

慢性阻塞性肺疾病(COPD)临床路径的实施处于起步阶段,在实施过程中遇到一些困惑。各级医院应在卫生部下发的COPD临床路径的基础上制定符合本单位实际的临床路径,这样才有利于在实践中不断创新,解决目前路径及疾病诊治指南中存在的问题,如制定临床简便可行的严重程度评估系统、初始经验性抗菌药物的时机、抗菌药物的疗程、COPD急性加重(AECOPD)患者激素的应用问题及出院时机的掌握等,以循证医学为依据,不断修改完善临床路径,促进COPD研究的进展。

Summary：Some problems emerge as the implementation of clinical pathway of COPD is now at its initial stage. Hospitals at different levels should adapt the Moll-released COPD clinical pathway to specific situations of their own, so as to innovate through practice, and to address the problems hidden in the current pathway and guidelines for treatment and diagnosis. Relevant measures may include developing a clinically simple and feasible assessment system for severity of COPD, determining the time window for initial use of empirical antibiotic therapy and the course of treatment, strategies for glucocorticoid therapy in AECOPD and when to discharge the patients. An evidence-based refinement of clinical pathway for COPD would promote research on this topic.