应用临床路径实施全程管理对痛风达标治疗的作用研究

Effect of clinical pathway management on qualified treatment for patients with gout

目的探讨通过临床路径实施的一种标准化全程管理模式在痛风达标治疗中的作用。方法将2020年3月至2021年3月期间来广州市荔湾中心医院就诊的1147例原发性痛风患者纳入研究,患者按随机挂号分到试验组或对照组。643例患者作为试验组进行标准化全程管理(以临床路径的形式实施),其中510例规律复诊并完成研究,男465例、女45例,年龄17~87(52±16)岁;504例患者作为对照组,其中213例规律复诊并完成研究,男194例、女19例,年龄15~81(51±13)岁。观察期1年,定期复查血尿酸水平、关节超声等指标并记录复诊情况。统计学方法采用t检验、χ^(2)检验。结果试验组复诊率、血尿酸达标率、临床治愈率分别为79.2%(404/510)、54.3%(277/510)及3.5%(18/510),对照组分别为42.3%(90/213)、18.3%(39/213)、0.5%(1/213),试验组上述各指标均高于对照组,差异均有统计学意义(χ^(2)=166.486、45.498、5.496,均P<0.05)。结论通过临床路径实施标准化的全程管理模式,能明显提高痛风患者复诊率、血尿酸持续达标率和临床治愈率。

Objective To study the effect of clinical pathway management on qualified treatment for patients with gout.Methods A total of 1147 patients with primary gout who were treated at Liwan Central Hospital from March 2020 to March 2021 were included in the study.The patients were randomly assigned to a test group(643 cases)and a control group(504 cases)according to the registration.The test group carried out standardized whom-process management(implemented in the form of clinical pathway);of which 510 patients were regularly revisited and completed the study,including 465 males and 45 females who were 17-87(52±16)years old.In the control group,213 patients were regularly revisited and completed the study,including 194 males and 19 females who were 15-81(51±13)years old.The observation period was one year.The serum uric acid level,joint ultrasound,and other indicators were regularly re-examined;the situation of subsequent visit was recorded.The data were analyzed by t andχ^(2) tests.Results The subsequent visit rate,the qualified rate of serum uric acid,and clinical cured rate in the test group were 79.2%(404/510),54.3%(277/510),and 3.5%(18/510);those in the control group were 42.3%(90/213),18.3%(39/213),and 0.5%(1/213),respectively;there were statistical differences between these two groups(χ^(2)=166.486,45.498,and 5.496;all P<0.05).Conclusion Clinical pathway management can significantly improve the subsequent visit rate of gout patients,qualified rate of serum uric acid,and clinical cured rate.