暴聋中西医结合临床路径的应用及疗效分析

Application of Clinical Pathway of Integrated Chinese and Western Medicine in Sudden Deafness and Its Curative Effect Analysis

【目的】探讨暴聋中西医结合临床路径对暴聋(突发性聋)患者治疗的意义。【方法】收集2015年1月至2019年12月期间在广东省中医院耳鼻咽喉科住院治疗且临床资料完整的暴聋患者,共642例(660耳)。其中,纳入暴聋临床路径的543例(556耳)患者为路径组,未纳入暴聋临床路径的99例(104耳)患者为非路径组。比较路径组与非路径组患者的住院天数、住院总费用和住院满意度,评价2组患者的不同听力曲线分型(低频下降型、高频下降型、平坦下降型、全聋型)疗效及其整体疗效,观察听力曲线分型、听力损失程度、发病后干预天数及发病年龄与疗效的关系。【结果】(1)整体疗效:路径组的总有效率为46.58%(259/556),非路径组为49.04%(51/104);组间比较,差异无统计学意义(P>0.05)。(2)各听力曲线分型疗效:路径组的低频下降型、高频下降型、平坦下降型及全聋型患者的总有效率分别为73.68%(84/114)、35.48%(11/31)、40.74%(110/270)、38.30%(54/141),非路径组分别为56.25%(9/16)、75.00%(3/4)、42.00%(21/50)、52.94%(18/34);组间各听力曲线分型疗效比较,差异均无统计学意义(P>0.05)。(3)路径组的住院天数和住院费用明显低于非路径组,住院满意度明显高于非路径组,差异均有统计学意义(P<0.05或P<0.01)。(4)不同听力曲线分型的疗效存在不同(P<0.01),其中以低频下降型的疗效为最好,总有效率达71.54%(93/130);不同听力损失程度的疗效存在不同(P<0.01),随着听力损失增加,总有效率逐渐下降;不同发病年龄段的疗效存在不同(P<0.01),随着发病年龄的增长,总有效率呈逐渐下降趋势;不同发病后干预时间的疗效存在不同(P<0.01),随着发病后干预时间的延长,总有效率呈逐渐下降趋势。【结论】暴聋中西医结合临床路径可以提供更优质的医疗质量,可以明显缩短患者住院天数,降低住院费用,提高住院满意度,但在疗效上路径组与非路径组未显示出统计学差异。

Objective To investigate the clinical significance of clinical pathway of integrated Chinese and Western medicine in the treatment of sudden deafness. Methods A total of 642 patients with sudden deafness(660 ears)who were hospitalized in the Department of Otorhinolaryngology, Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2015 to December 2019 and having complete clinical data were enrolled into the analysis. Among them, 543 patients(556 ears)who were included in the clinical pathway of sudden deafness served as the pathway group,and 99 patients(104 ears)who were not included in the clinical pathway of sudden deafness served as the non-pathway group. The hospitalization days,total hospitalization costs and hospitalization satisfaction in the pathway group and non-pathway group were compared, and the curative effect for different hearing curve types(low-frequency descending type, high-frequency descending type, flat descending type,total deafness type)and the overall effect in the two groups were also evaluated. Meanwhile,the correlation of the hearing curve types,the degree of hearing loss,intervention days after onset,and onset age with the curative effect was explored. Results(1)Overall efficacy:the total effective rate was 46.58%(259/556)in the pathway group and 49.04%(51/104)in the non-pathway group,and there was no significant difference between the two groups(P > 0.05).(2)Efficacy for various hearing curve types: the total effective rates for low-frequency descending type,high-frequency descending type,flat descending type,and total deafness type in the pathway group were 73.68%(84/114), 35.48%(11/31), 40.74%(110/270)and 38.30%(54/141) respectively, and those in the non-pathway group were 56.25%(9/16), 75.00%(3/4), 42.00%(21/50), 52.94%(18/34)respectively. The intergroup comparison showed that there was no statistical significance in the efficacy for various hearing curve types between the two groups(P > 0.05).(3)The hospitalization days and total hospitalization costs in the pathway group were significantly lower than those in the non-pathway group, and the hospitalization satisfaction was significantly higher than that in the non-pathway group, the difference being statistically significant(P < 0.05 or P < 0.01).(4)The efficacy for various hearing curve types was different(P < 0.01),and the efficacy for low-frequency descending type was the best,with a total effective rate of 71.54%(93/130). The curative effect for various deafness degrees was different(P < 0.01), and the total effective rate gradually decreased along with the increase of hearing loss. The curative effect was different in various age groups(P <0.01),and the total effective rate was gradually decreased along with the increase of age. The curative effect for various intervention time after onset was different(P < 0.01), and the total effective rate showed a gradual downward trend with the extension of intervention time. Conclusion The clinical pathway of integrated Chinese and western medicine can provide better medical quality for sudden deafness patients through shortening the hospitalization days,reducing hospitalization costs and improving hospitalization satisfaction. However,there is no statistical difference in the efficacy between the pathway group and the non-pathway group.