临床路径在普外科3病种的应用研究

Application research on clinical pathway of 3 types of diseases in general surgery

目的探讨临床路径文本的设计方法及应用效果。方法依据循证医学、中位数法、帕雷托原理等理念和方法,设计阑尾炎、腹股沟疝、交通性鞘膜积液3个普外科病种的临床路径文本,并用设计好的文本对这3个病种实施临床路径治疗,对实施临床路径的效果进行分析评价。结果收集2013年1月~2014年10月3个病种实施临床路径治疗组（路径组）和传统治疗组（对照组）病历资料,所有进入路径的患者均能按设计的诊疗内容完成治疗并在设计的时间内出院;3个病种平均住院天数路径组比对照组减少3~4d,平均住院总费用路径组明显低于对照组,经统计分析路径组和对照组在平均住院天数和平均住院总费用方面差异有统计学意义（P〈0.05）;3个病种路径组和对照组患者满意度调查满意率均≥98%,术后3~6个月随访,均恢复良好,无并发症发生,路径组和对照组无明显差别。结论应用临床路径对3个病种进行治疗,切实能保证医疗安全、减少平均住院天数、降低平均住院总费用、提高患者满意度。

Objective To investigate the method of context design and the application effect of clinical pathway. Methods According to the theories of evidence-based medicine（EBM）, Pareto Principle and Median Method, the project of clinical pathway of three types of diseases（appendicitis, Inguinal hernia, Communicating hydrocele）was designed and subsequently applied in practice. Finally, the effect of the project was accessed. Results From January 2013 to October 2014, the clinical datasets of the clinical pathway treatment group（intervention group） and conventional treatment group（control group） were collected and analyzed. The patients from the Intervention Group completed the treatment and discharged on schedule. The average days of hospitalization of the Intervention Group were 3 to 4 days more than the Control Group. And the average expense of hospitalization of Intervention Group was significantly lower than the Control Group（P〈0.05）. The degree of satisfaction of both groups was greater than 98% and does not show significant difference. Conclution Application of clinical pathway could reduce the expense and the length of hospitalization for the treatment of three types of diseases in general surgery.