颈动脉内膜切除手术的临床路径管理

Clinical path management of carotid endarterectomy

目的探讨临床路径在颈动脉内膜切除术(carotid endarterectomy,CEA)治疗颈动脉狭窄中的作用。方法回顾性分析273例因颈动脉狭窄实施CEA的病例资料,依据是否纳入临床路径分为临床路径组(n=126)和非临床路径组(n=147),对比两组在临床质量管理方面的差异。结果两组在治疗效果及病人评价方面无统计学差异;临床路径组医疗效率显著高于非临床路径组(住院天数分别为8.3 d,10.5 d);临床路径组总费用显著低于非临床路径组。在院内感染和抗菌药物方面,非临床路径组中有接近三分之一常规使用抗菌药物,但在临床路径管理下,仅1例因特殊情况而使用抗生素。结论 CEA确实非常适合采用临床路径管理,确保了医疗质量,增加临床医疗的规范性和工作效率。

Objective To investigate the role of clinical pathway （CP） in carotid endarterectomy （CEA） for carotid stenosis. Methods Clinical data of 273 patients with carotid stenosis undergoing CEA were analyzed retrospectively. According to whether the patient was included into the CP, these patients were divided into CP group （n = 126） and non-CP group （n = 147）, and the differences in terms of clinical quality management were compared between the two groups. Results Two groups of patients showed no statistical difference in the clinical efficacy and patient evaluation. The medical efficacy was significantly higher in the CP group than in the non-CP group and the hospital days were 8.3 days and 10.5 days respectively. The total cost was significantly lower in CP group than non-CP group. Nearly a third of patients received common antimicrobial drugs for nosocomial infections in non-CP group, hut, only one patient took antibiotics for a specific condition in the CP group. Conclusions CEA indeed needs clinical pathway management, which could ensure the quality of medical care and increase the normality and efficiency of health care.