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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 567 -570. doi: 10.3877/cma.j.issn.1674-3946.2019.06.009.

所属专题： 文献；

论著

肝泡型包虫病临床路径实施效果评价
段帅1, 吐尔干艾力·阿吉1, 蒋铁民1, 冉博1, 郭强1, 邵英梅1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院消化血管中心肝胆包虫科
  • 收稿日期:2019-04-04 出版日期:2019-12-26
  • 通信作者: 邵英梅

Evaluation of clinical pathway in the therapeutic treatment hepatic alveolar echinococcosis

shuai Duan1, Aji Tuerganaili·1, Tiemin Jiang1, Bo Ran1, Qiang Guo1, Yingmei Shao1,†()   

  1. 1. Department of hepatobiliary hydatidosis surgery, digestive and vascular surgery center, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang 830054, China
  • Received:2019-04-04 Published:2019-12-26
  • Corresponding author: Yingmei Shao
  • About author:
    Corresponding author: Shao Yingmei, Email:
  • Supported by:
    Key discipline (Peak discipline) of the 13th-five-year plan of the Autonomous Region(new teaching and Research (2016) No.7); National Natural Science Foundation of China(NO.81560098)
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段帅, 吐尔干艾力·阿吉, 蒋铁民, 冉博, 郭强, 邵英梅. 肝泡型包虫病临床路径实施效果评价[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(06): 567-570.

shuai Duan, Aji Tuerganaili·, Tiemin Jiang, Bo Ran, Qiang Guo, Yingmei Shao. Evaluation of clinical pathway in the therapeutic treatment hepatic alveolar echinococcosis[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(06): 567-570.

目的

评价肝泡型包虫病(HAE)临床路径(CP)的实施效果。

方法

回顾性分析并比较纳入临床路径诊治的84例(CP组)和未纳入临床路径诊治的86例(非CP组) HAE病患者临床疗效。运用SPSS 19.0统计软件进行数据分析，术后各项指标以(±s)表示，独立t检验；术后并发症发生率采用χ2检验。以P<0.05为差异有统计学意义。

结果

CP组患者的住院时间(10.9±1.3) d和住院费用(3.5±0.3)万元低于非CP组[(14.1±1.2) d、(3.8±0.4)万元]，P<0.05；CP组患者的满意度更高、出院时包虫病健康知识掌握情况亦优于非CP组(P<0.05)。两组患者在术后并发症发生情况方面差异无统计学意义(P>0.05)。

结论

实施HAE临床路径可有效缩短患者住院时间，降低诊疗费用、减轻患者经济负担，对提升患者满意度、普及包虫病健康知识具有积极作用，值得临床应用和推广，但临床路径的变异发生率较高，需要及时进行干预与不断优化管理以适用于临床。

关键词: 棘球蚴病，肝, 临床路径, 变异
Objective

To evaluate the effect of clinical pathway (CP) in the therapeutic treatment hepatic alveolar echinococcosis (HAE).

Methods

The clinical data were analyzed retrospectively, including 84 patients in CP group and 86 patients in non-CP group. Statistical analysis was performed by using SPSS 19.0 software. Measurement data were expressed as mean±standard deviation and were examined by independent t test. Count data such as the incidence of postoperative complications were described by (n, %) and were examined by chi square test. The correlation between predicted resected liver volume and actual resected liver volume were also analyzed. A P value of <0.05 was considered as statistically significant.

Results

The hospitalization time of (10.9±1.3) d and hospitalization expenses of (35±3) thousand yuan in the CP group were significantly lower than (14.1±1.2) d and (38±4) thousand yuan in the non-CP group respectively, P<0.05; The patient’s satisfaction in CP group was higher, and the knowledge of echinococcosis health at discharge was better than those in non-CP group respectively (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).

Conclusion

Implementing the clinical pathway of HAE could effectively shorten the hospitalization time, reduce the cost of treatment as well as the economic burden of patients, and has a positive effect on improving patient satisfaction and popularizing the health knowledge of echinococcosis. It is worthy of clinical application and promotion, but the incidence of mutations in the clinical pathway is high, requiring timely intervention and continuous optimization management for clinical use.

Key words: Echinococcosis, hepatic, Critical pathways, Variation
表1 170例HAE患者不同临床路径两组一般情况比较(例)
组别 例数 年龄[(±s)，岁] 性别 既往手术史
男/女 有/无
CP组 84 32.6±7.2 44/40 10/74
非CP组 86 33.9±7.8 48/38 13/73
t/χ2值 ? 1.151 0.202 0.375
P值 ? >0.05 >0.05 >0.05
组别 例数 手术方式
A/B/C/D/E/F/G/H
CP组 84 5/12/19/7/16/13/7/5
非CP组 86 6/14/16/8/13/15/8/6
χ2值 ? 0.074/0.003/0.419/0.050/0.464/0.119/0.050/0.074
P值 ? >0.05
表2 170例HAE患者不同临床路径两组患者术后各项指标比较(±s)
组别 例数 住院时间(d) 住院费用(万元) 满意度(%) 包虫病健康知识(%)
CP组 84 10.9±1.3 3.5±0.3 47.2±1.4 84.8±6.3
非CP组 86 14.1±1.2 3.8±0.4 43.8±1.4 74.3±11.1
t值 ? 16.520 5.933 －15.939 －7.522
P值 ? <0.05 <0.05 <0.05 <0.05
表3 170例HAE患者不同临床路径两组患者术后并发症比较(例)
组别 例数 胆漏 肝功能不全 出血 感染
CP组 84 8 5 1 7
非CP组 86 10 7 2 9
χ2值 ? 0.199 0.310 0.000 0.227
P值 ? 0.656 0.578 1.000 0.634
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