儿童毛细支气管炎临床路径实施效果评价

Evaluation of clinical pathway introduced in children with bronchiolitis

目的评估儿童毛细支气管炎临床路径的实施效果。方法采用回顾性研究方法，分析并比较采用临床路径治疗的181例（临床路径组）和非临床路径治疗的122例毛细支气管炎患儿（对照组）在住院时间、住院费用、抗生素使用率、治愈率、院内感染率等方面的差异，讨论临床路径的变异情况。结果临床路径组住院时间为4.96 d（4.00 d，6.00 d），短于对照组[5.81 d（4.82 d，7.00 d）]，差异有统计学意义（Z＝3.137，P〈0.05）；住院费用为3 701.23元（3 124.50元，4 396.19元），低于对照组[3 954.22元（3 325.07元，4 679.66元）]，差异有统计学意义（Z＝2.042，P〈0.05）。临床路径组抗生素使用率为20.44%（37/181例），低于对照组的40.16%（49/122例），差异有统计学意义（χ^2＝13.945，P〈0.05）；临床路径组治愈率为93.92%（170/181例），高于对照组的86.89%（106/122例），差异有统计学意义（χ^2＝4.447，P〈0.05）；临床路径组院内感染率为4.42%（8/181例），低于对照组的10.66%（13/122例），差异有统计学意义（χ^2＝4.393，P〈0.05）；临床路径变异率为48.62%（88/181例）。结论临床路径应用于儿童毛细支气管炎可以提高疾病的治愈率，缩短患儿住院时间，降低住院费用，降低抗生素使用率，降低院内感染率，值得推广使用。但临床路径的变异率较高，需及时进行干预与管理以适用于临床。

Objective To investigate the efficacy of the clinical pathway introduced in children with bronchiolitis.Methods Based on a retrospective study, the duration of hospital stay, hospital expenses, antibiotics usage rates, curative rate and nosocomial infection rate were compared between 181 bronchiolitis patients （the clinical pathway group） managed according to clinical pathway and other 122 bronchiolitis patients （the control group）. The variation of clinical pathway was analyzed in the clinical pathway group as well.Results The duration of hospital stay in clinical pathway group [4.96（4.00, 6.00） days] was significantly shorter than that in the control group [5.81 （4.82, 7.00） days], and the difference was significant （Z=3.137, P〈0.05）. The hospital expenses [3 701.23（3 124.50, 4 396.19） yuan]in clinical pathway group were significantly lower than that in the control group [3 954.22（3 325.07, 4 679.66） yuan], and the difference was significant（Z=2.042, P〈0.05）. The antibiotics usage rate （20.44%）（37/181 cases） in clinical pathway group was significantly lower than that in the control group （40.16%）（49/122 cases）, and the difference was significant（χ^2=13.945, P〈0.05）, and the curative rate （93.92%）（170/181 cases）in clinical pathway group was significantly higher than that in the control group （86.89%）（106/122 cases）, and the difference was significant（χ^2=4.447, P〈0.05） .The nosocomial infection rate （4.42%） （8/181 cases）was also lower than that in the control group （10.66%, 13/122 cases）, and the difference was significant （χ^2=4.393, P〈0.05）. The variation rate of clinical pathway was 48.62% （88/181 cases） in clinical pathway group.Conclusions The curative rate is improved and the duration of hospital can be shortened if the clinical pathway is introduced in bronchiolitis children, with less the hospital expense.Moreover, the antibiotics usage rates and the nosocomial infection rate are reduced in the implementation process of clinical pathway which is worthy to be put in use.However, there is a high variation rate in the clinical pathway.It should be interposed and administrated appropriately in dinical treatment for clinic.