临床路径对儿童肺炎的管理作用分析

Effect of clinical pathway management on pediatric pneumonia

目的探讨临床路径管理对儿童肺炎的管理效果。方法收集重庆医科大学附属儿童医院呼吸二病房2011年1月至2012年12月期间住院并诊断为支气管肺炎、毛细支气管炎、支原体肺炎患儿资料，根据是否实行临床路径管理分为路径管理组（405例，年龄1个月～15岁）和非路径管理组（503例，年龄1个月～11岁），评价两组住院天数、住院费用、临床疗效以及抗生素使用情况。结果路径管理组支气管肺炎、毛细支气管炎患儿平均住院天数分别为（6．1±1．6）d、（6．2±1．5）d，非路径管理组为（7．2±1．9）d、（7．3±1．5）d，差异有统计学意义（P=0．000），两组支原体肺炎患儿住院天数[（6．9±1．8）d一（7．74-2．5）d]比较差异无统计学意义（P=0．198）；支气管肺炎、毛细支气管炎、支原体肺炎三个病种检验费路径管理组较非路径管理组稍高，其余各费用均较非路径管理组低。路径管理组和非路径管理组中支气管肺炎、毛细支气管炎和支原体肺炎总费用分别为（4609±1225）元VS．（5629±1813）元、（5006±1250）元＂US．（5686±1337）元、（49464-1259）元m（64884-3032）元，路径管理组均低于非路径管理组（P〈0．05）。抗生素使用率[（70．9％VS．99．4％）、（45．7％93．4％）、（96．2％w．100．0％）]路径管理组均低于非路径管理组（P〈0．05）。抗生素使用天数、联用情况及抗生素使用级别在路径管理组明显改善（P〈0．01）。两组间临床疗效及30d内同一疾病非计划再人院差异无统计学意义（P〉0．05）。结论临床路径管理在规范医疗行为的同时降低医疗成本，避免了过度用药、检查及治疗，特别是在抗生素管理方面突显成效，值得临床推广应用。

Objective To investigate effect of clinical pathway management on pediatric pneumonia. Method Data were colleted from children hospitalizated with bronchial pneumonia, bronchiolitis ,mycoplasma pneumonia in Center of Respiratory Disorders in Children＇s Hospital of Chongqing Medical University from January 2011 to, December 2012. According to implement of clinical pathway management, all patients were divided into pathway management group （n = 405 ） and non-pathway management group （ n = 503 ）. Length of stay, costs of hospitalization, clinical effect and use of antibiotics were compared in these two groups. Result In pathway management group, average length of stay of children with bronchial pneumonia and bronchiolitis was （6. 1 ＋ 1.6） d and （6. 2 ＋ 1.5 ） d respectively. While in non-pathway management group,length of stay was （7.2 ＋ 1.9） d and （7.3 _＋ 1.5 ） d （ P = 0. 000）. There was no significant difference in length of stay between these two groups of children with mycoplasma pneumonia [（6.9_＋ 1.8） d vs. （7.7 ＋ 2.5） d （P = 0.198）.Costs of auxiliary tests in pathway management group was slightly higher than that in non-pathway management group. While other costs in pathway management group were significantly lower than those in non-pathway management group. Total costs of hospitalization of patients with these three diseases in pathway management group and non-pathway management group were （4609 ＋ 1225） vs （5629 ＋ 1813）, （5006 ＋ 1250） vs. （5686 ＋ 1337）, （4946 ＋ 1259） vs. （6488 ＋ 3032） respectively. There was a significant difference （P 〈 0. 05）. Percentages of antibiotics use in two groups were 70. 9% vs. 99.4% , 45.7% vs. 93.4% and 96.2% vs. 100. 0%. Antibiotics related indicators such as mean number of day of use, ratio of combination and grade of antibiotics were significantly higher in pathway management group compared to non-pathway management group （P 〈 0. 01 ）. There was no signifieant difference in other indicators like clinical effect and unseheduled readmission in 30 days between two groups （ P 〉 0. 05 ） . Conclusion Clinical pathwaymanagement can regulate medical behaviors through reduction of medical costs, avoidance of excessive laboratory tests and therapy, and regulation of antibiotic use.