临床路径在75岁及以上老年脑梗死患者中的应用效果评价

Assessment of the application of clinical pathways for cerebral infarction in patients aged 75 years and above

目的评价临床路径在75岁及以上老年脑梗死患者中的安全性及治疗效果。方法选择2016年1月至2018年6月在南阳市中心医院神经内科≥75岁的老年脑梗死患者,排除临床变异退出患者后共纳入363例患者,分为临床路径组184例和对照组179例,比较两组患者90 d后改良Rankin量表评分(mRS)、病死率、并发症发生率、平均住院日、住院总费用以及药费。结果临床路径组患者90 d后mRS 0~1分比例77.2%(142/184),较对照组比例(55.3%,99/179)更高(χ^2=19.443,P=0.000);住院期间肺部感染以及下肢深静脉血栓发生率23.9%(44/184)、14.7%(27/184),低于对照组42.5%(76/179)、29.1%(52/179)(χ^2=14.101、11.014,P=0.000、0.001),两组患者病死率差异也有统计学意义[4.9%(9/184)比11.2%(20/179),χ^2=4.871,P=0.027];其他并发症发生率差异均无统计学意义(均P>0.05);临床路径组患者平均住院日(18.3±2.9)d、总费用(2.72±0.42)万元、药费(0.87±0.29)万元,均低于对照组(22.8±4.4)d、(3.55±0.81)万元、(1.42±0.29)万元(t=11.546、12.168、18.335,均P=0.000)。结论临床路径可以提高老年脑梗死患者的医疗质量、缩短老年急性缺血性脑梗死患者的住院日、降低住院费用及药费。

Objective To evaluate the safety and therapeutic efficacy of clinical pathways(CP)for cerebral infarction in patients aged 75 years and above.Methods A cohort of 363 cerebral infarction patients aged 75 years and above after excluding clinical variants were recruited from January 2016 to June 2018 at the neurology department of Nanyang City Center Hospital.Patients were randomly divided into the CP group(n=184)and the control group(n=179).The day-90 modified Rankin scale score(mRS),mortality,incidences of complications,length of hospital stay,total hospital costs and drug costs were compared between the two groups.Results The proportion of patients with mRS 0-1 was higher in the CP group than in the control group(77.2%or 142/184 vs.55.3%or 99/179,χ^2=19.443,P=0.000).The incidences of pulmonary infection(23.9%,44/184)and deep venous thrombosis(14.7%,27/184)were lower in the CP group than in the control group(42.5%,76/179&29.1%,52/179;χ^2=14.101,11.014,P=0.000,0.001).There was a significant difference in mortality between the two groups[4.9%(9/184)vs.11.2%(20/179),χ^2=4.871,P=0.027].There was no significant difference in the other incidences of complications between the groups(P>0.05).Hospital stay length(18.3±2.9)d,total cost(2.72±0.42)×10^4 yuan,and drug cost(0.87±0.29)×10^4 yuan in the clinical pathway group were lower than those in the control group[(22.8±4.4)d,(3.55±0.81)×104 yuan,(1.42±0.29)×10^4 yuan](t=11.546,12.168 and 18.335,all P=0.000).Conclusions The adoption of clinical pathways can improve medical quality,shorten hospitalization days and reduce hospitalization costs and medical costs in elderly patients with cerebral infarction.