北京儿童医院先天性肌性斜颈临床路径实施前后效果评价

Evaluations of the clinical pathway of congenital muscular torticollis in Beijing Children's Hospital

目的:评估首都医科大学附属北京儿童医院先天性肌性斜颈患儿临床路径实施效果。方法:采用回顾性对照分析方法,以2009年1月~2012年1月未实施临床路径的156例先天性肌性斜颈患儿为对照组,以2013年1月~2016年1月实施临床路径的126例先天性肌性斜颈患儿为实验组,观察比较两组之间的差异。观察指标包括:术前住院天数、术后住院天数、住院总天数、住院费用、抗菌药物使用情况、再手术、并发症等。结果:实验组术前住院天数、术后住院天数、住院总天数;床位费用、麻醉费用低于对照组;手术费用、西药费用、一次性材料费用、住院总费用高于对照组,以上两组比较均具有统计学意义(P<0.05)。对照组有2例患儿术后出现伤口渗血,实验组术后无明显并发症;对照组有1例患儿行二次手术,实验组无再次手术患儿;对照组术后抗菌药物使用时间超过24 h的比率为83.33%(130/156),而实验组术后抗菌药物使用时间超过24 h的比率为0.79%(1/126)。实施临床路径后变异率为49.64%(69/139)。结论:实施临床路径可以缩短先天性肌性斜颈患儿的住院天数,规范抗菌药物的使用,且术后无明显并发症,但住院费用较前增加,且实施过程中变异率较高,因此需对临床路径加以完善并推广使用。

Objective： To investigate the efficacy of the clinical pathway introduced in children with congenital muscular torticollis in Beijing Children＇s Hospital affiliated to Capital Medical University. Methods： The clinical pathways not implemented of 156 patients with congenital muscular torticollis were selected as the control group from January 2009 to January 2012. The clinical pathways implemented of 126 patients with congenital muscular torticollis were enrolled as the test group. Using the retrospective and contrastive analysis method to observe and compare the difference between the two groups. The observation indicators include： preoperative hospital stay, postoperative hospital stay, total length of hospital stay, hospital costs, antibiotics used, reoperation, complications and so on. Results：The preoperative hospital stay, postoperative hospital stay, total length of hospital stay in clinical pathway group were shorter than that in the control group（4.00±2.27,3.90±1.26,7.88±2.92 d）. The bed expenses, anesthesia fees were lower than that in the control group. The cost of operation, the cost of western medicine, the cost of disposable materials, the total hospital costs were higher than that in the control group. All of above, differences were statistically significant（P0.05）. In the control group, 2 cases had wound bleeding after operation, and there was no obvious complication in the test group. 1 case underwent secondary surgery in the control group and no patients in the test group. The ratio of the control group using antibiotics more than 24 hours after operation is 83.33%（130/156）, while the ratio of the test group is 0.79%（1/126）. The variation rate after implementing the clinical pathway was 49.64%（69/139）. Conclusion：The implementation of clinical pathways can shorten the length of hospital stay in children with congenital muscular torticollis, regulate the use of antibiotics and no significant complications after surgery. While the cost of hospitalization increased, and there is a high variation rate, so it is need for the clinical pathway to be refined and promoted. And it is necessary to optimize the clinical pathway before it is adapted in clinic.