中医临床路径对老年肝肾亏虚型腰椎间盘突出症疗效和效益的影响

Curative Effect of TCM Clinical Pathway on Liver-kidney-deficiency Lumbar Disc Herniation in the Elderly and the Benefit

目的观察中医临床路径对老年肝肾亏虚型腰椎间盘突出症患者的临床疗效和临床效益。方法纳入复旦大学附属华东医院伤外科2017年10月—2018年9月实施临床路径的肝肾亏虚型腰椎间盘突出症老年患者作为路径组(n=50);2016年10月—2017年9月未实施临床路径诊疗的肝肾亏虚型腰椎间盘突出症老年患者为对照组(n=48),比较2组的VAS评分、治疗有效率、住院天数和住院费用等。结果路径组治疗后的VAS评分低于对照组[(21.58±5.65)mm vs(25.40±8.69)mm, P=0.012],治疗总有效率高于对照组(96.0%vs 81.3%, P=0.049)。路径组西药费较对照组减少[(2 465.13±1 066.92)元vs(3 872.60±1 318.53)元, P<0.001],住院总费用也较对照组下降[(11 874.37±2 249.79)元vs (13 157.02±2 881.12)元, P=0.016],2组在住院天数和中医治疗费方面差异无统计学意义。结论中医临床路径能改善腰椎间盘突出症老年患者的腰腿疼痛,减少医疗费用支出,改善老年患者生活质量,具有一定的临床推广价值。

Objective To observe the curative effect of clinical pathway with Traditional Chinese Medicine(TCM) on liver-kidney-deficiency lumbar disc herniation(LDH) in the elderly and the benefit. Methods 50 elderly with liver-kidney-deficiency lumbar disc herniation during the period from Oct., 2017 to Sept., 2018 were enrolled in clinical pathway group and clinical pathway was performed while 48 elderly with liver-kidney-deficiency lumbar disc herniation during the period from Oct.,2016 to Sept., 2017 were enrolled in control group without clinical pathway performance;a comparative study was made to the VAS score, the effective rate, hospitalization days and hospitalization expenses between the 2 groups. ResultsAfter treatment,the VAS score was lower in clincal pathway group than that in control group [(21.58±5.65) mm vs(25.40±8.69) mm, P=0.012]and the total effective rate in clincal pathway group was 96.0%, higher than that in control group(81.3%)(P=0.049);the expense of Western medicine in clincal pathway group was less than that in control group [(2 465.13±1 066.92) RMB yuan vs(3 872.60±1 318.53) RMB yuan, P<0.001] as well as the total hospitalization expense [(11 874.37±2 249.79) RMB yuan vs(13 157.02±2 881.12) RMB yuan, P=0.016];no statistical differences in hospitalization days and the expense in TCM were found between the 2 groups. Conclusions TCM clincal pathway can alleviate lumbocrural pain in the elderly with LDH, reduce the hospitalization expenses and improve the quality of life, which is worthy of clinical application.