临床路径在克罗恩病合并肠梗阻诊疗中的应用

Effect of a clinical pathway in patients with Crohn＇s disease complicated with intestinal obstruction

目的 评价临床路径在克罗恩病合并肠梗阻患者诊疗中的实施效果。方法 纳入南京军区南京总医院炎症性肠病治疗中心2014年3月至2015年9月间入院诊治的119例克罗恩病合并肠梗阻患者为临床路径组（按临床路径进行诊治，该临床路径是基于循证医学证据并结合中心自身诊疗经验制订），并选取2012年9月至2014年2月间住院治疗的路径实施前入院诊治的108例克罗恩病合并肠梗阻患者为非临床路径组（由收治医师制定诊治方案），比较两组患者的手术率、肠造口率、手术并发症发生率、住院时间、住院费用及非计划6月内再入院率。结果 两组患者基线资料的差异无统计学意义（P 〉 0.05），具有可比性。临床路径组与非临床路径组患者手术率[73.9%（88/119）比77.8%（84/108）]、肠造口率[15.9%（14/88）比25.0%（21/84）]及术后并发症发生率[23.9%（21/88）比27.4%（23/84）]的差异均无统计学意义（均P 〉 0.05 ）。临床路径组较非临床路径组患者术后平均住院时间缩短（10.9 d比13.2 d，P= 0.000），平均住院费用减少（78 325元比85 310元，P= 0.031），再住院率降低[3.4%（4/119）比11.1%（12/108），P= 0.035]。结论 遵照临床路径进行诊治能够有效降低克罗恩病合并肠梗阻的非计划再住院率，并缩短手术患者的术后住院时间，减少住院费用。

Objective To evaluate the effect of a clinical pathway for Crohn disease （CD） complicated with intestinal obstruction.Methods CD patients complicated with intestinal obstruction in Inflammatory Bowel Disease （IBD） Center of Jinling Hospital were enrolled. One hundred and nineteen CD patients from March 2014 to September 2015 received treatment with the clinical pathway （CP） , which was developed based on medical evidence and experience of the IBD center in February 2014, as CP group. The other 108 CD patients from September 2012 to February 2014 received treatment according to the management strategy made by individual attending physician as non-CP group. Rate of operation, rate of stoma, morbidity of surgical complications, hospital stay, hospital cost, and 6-month unplanned re-admission were compared between two groups.Results The baseline data were similar between the two group （all P 〉 0.05）. No significant differences were noted between these the two groups in terms of rate of operation （73.9% vs. 77.8%, P = 0.605） , rate of stoma （15.9% vs. 25.0%, P = 0.197） , and morbidity of surgical complications （23.9% vs. 27.4%, P = 0.724）. However, the mean postoperative hospital stay was shorter （10.9 d vs. 13.2 d, P = 0.000） , the mean hospital cost was less （78 325 Yuan vs. 85 310 Yuan, P = 0.031） and the rate of 6-month unplanned re-admission was lower （3.4% vs. 11.1%, P = 0.035） in CP group.Conclusion Treatment based on this CP for CD patients complicated with intestinal obstruction can reduce the rate of 6-month unplanned re-admission, shorten the postoperative hospital stay and decrease the hospital cost in patients requiring surgery.