克罗恩病合并腹腔脓肿临床路径应用分析

Impact of clinical pathway on the treatment outcome in patients with Crohn's disease complicated with intraabdominal abscesses

目的评价克罗恩病(CD)合并腹腔脓肿临床路径的实施效果。方法回顾性分析2014年1-12月中国人民解放军南京总医院炎症性肠病治疗中心连续收治的进入临床路径的30例CD合并腹腔脓肿病人(路径组)临床资料。同时,以2013年1-12月收治的30例未采用临床路径的CD合并腹腔脓肿病人(非路径组)为对照,分析比较两组病人的治疗效果。结果两组病人均全部治愈,无死亡病例。路径完成率为100%。路径组与非路径组手术率[80.0%(24/30)vs.66.7%(20/30)]、术后并发症发生率[29.2%(7/24)vs.50.0%(10/20)]、治疗费用[(56 745.2±45 465.4)元vs.(73 928.3±50 576.6)元]差异均无统计学意义(P>0.05);相对于非路径组,路径组病人临时性肠造口发生率降低[16.7%(4/24)vs.55.0%(11/20),P=0.011],住院时间缩短[(28.9±21.4)d vs.(43.8±34.3)d,P=0.047]。出院后随访1年,两组病人脓肿复发率差异无统计学意义(P=1.000)。结论临床路径在确保疗效和安全的前提下,优化了CD合并腹腔脓肿的治疗,使临时性肠造口发生率降低并缩短了住院时间,具有应用和推广价值。

Objective To evaluate the effect of a clinical pathway on treatment outcomes in patients with Crohn＇ s disease （CD） complicated with intra-abdominal abscesses. Methods The clinical data of 30 CD patients with intra-abdominal abscesses admitted from January 2014 to December 2014 in Inflammatory Bowel Disease Treatment Center of Nanjing General Hospital of Nanjing Military Area Command （ clinical pathway group ） were analyzed retrospectively. Meanwhile, 30 patients according to the implementation of the designed clinical pathway between January 2013 and December 2013 were non-pathway group. The treatment outcomes between the two groups were compared. Results All patients were cured in both groups. The completion rate of the clinical pathway used was 100%. No difference was noted in terms of the rate of surgery [80.0%（24/30） vs. 66.7%（20/30）], postoperative complications [29.2% （7/24） vs. 50.0% （10/20）] and hospital cost [ （56 745± 45 465） yuan vs. （73 928± 50 576） yuan]. However, compared with non-pathway group, the rate of temporary stoma was lower in pathway group [ 16.7%（4/24） vs. 55.0%（11/ 20）, P=0.011 ], and the LOS was shorter [ （28.9±21.4）d vs. （43.8±34.3）d, P=0.047 ]. In addition, during the one year of follow-up period, there was no meaningful difference in the recurrence of abscesses between the two groups （P=1.000）. Conclusion Clinical pathway may decrease the intestinal stoma rate and LOS in CD patients complicated with intra-abdominal abscesses.