小康型乡镇医院实施阑尾炎病种临床路径的现状分析  

Implementation of Clinical Pathway for Appendicitis in A Township Hospital

作　　者：韩锋[1] 沈恒山[1] 王建良[1] 陈伟红[1] 戴俊忠 丁厚中[2] 

机构地区：[1]江苏省昆山市锦溪人民医院,215324 [2]江苏大学附属昆山市第一人民医院

出　　处：《中国全科医学》2012年第30期3504-3505,共2页Chinese General Practice

基　　金："十一五"国家科技支撑计划重点项目(2008BAI65B04)

摘　　要：目的分析小康型乡镇医院实施阑尾炎病种临床路径的现状。方法选取2010年1月—2011年11月我院收治的行手术治疗的阑尾炎患者185例为研究对象,均实施阑尾炎病种临床路径,总结分析患者的疾病种类、术前检查、误诊或漏诊原因、手术时间、术中出血量、住院时间、住院费用和预后情况。结果 185例患者中,急性化脓性阑尾炎123例、急性单纯性阑尾炎30例、坏疽性及穿孔性阑尾炎21例、慢性阑尾炎11例。术前检查:123例患者查血常规、尿常规、心电图;90例患者查腹部B超,14例(15.6%)提示阑尾炎、腹腔积液、包块;78例查腹部平片,3例(3.8%)提示肠腔积气、积液。术中及术后7例患者误诊或漏诊。手术时间15～100 min,平均45 min;术中出血量10～200 ml;住院时间4～10 d,平均6.5 d。住院费用2 980～4 560元,平均3 650元;其中治疗费用1 320～1 580元,平均1 410元;用药费用450～1 560元,平均980元。预后:115例4～5 d痊愈出院,62例6～7 d痊愈出院,3例出现切口感染、2例切口脂肪液化术后8～12 d痊愈出院,1例腹腔残余脓肿、1例炎性肠梗阻12～14 d痊愈出院,1例粪瘘19 d痊愈出院。结论临床路径的实施,作为一种规范化的医疗管理模式,在保证医疗质量的基础上,起到指引医生诊疗行为、监控医院质量、加强医院管理等作用、降低医药成本及保证医疗质量等作用。Objective To investigate the current implementation status of clinical pathway for appendicitis in a township hospital. Methods A total of 185 surgical cases of appendicitis in our hospital between January 2010 and November 2011 were included in the study. Data of disease types, preoperative examination, operation time, intraoperative blood loss, length of hospital stay, hospitalization expenses and prognosis were gathered and analyzed. Results Among the 185 cases of appendicitis, 123 cases were acute suppurative appendicitis, 30 cases were acute simple appendicitis, 21 gangrenous and perforating appendi- citis, and 11 chronic appendicitis. Routine blood examination, routine urine examination and electrocardiogram were checked in 123 cases. Abdominal ultrasound B scari indicated appendicitis, peritoneal effusion and lump in 14 out of 90 cases （ 15.6% ）. Abdominal plain film suggested enteric cavity pneumatosis and effusion in 3 out of 78 cases （3.8%）. Seven cases of error diagno- sis and missed diagnosis happened intraoperatively and postoperatively. The operation time was 15 - 100 rain （mean 45 min） ; intraoperative blood loss was 10 - 200 ml ; hospital stay was 4 - 10 d （ mean 6. 5 ） ; hospitalization expense 2 980 - 4 560 yuan RMB （mean 3 650 yuan RMB）, including treatment expense 1 320 - 1 580 yuan RMB （mean 1 410） and medication expense 450 - 1 560 yuan RMB （mean 980 yuan RMB）. Out of the 115 cases who were discharged 4 -5 d after the opration, 62 cases who were discharged 6 - 7 d after the opration, 3 cases of incision infection and 2 cases of incision fat liquefaction were discharged 8 - 12 d after the opration, 1 abdominal residual abscess and 1 inflammatory bowel obstruction were discharged 12 - 14 d after the opration, 1 fecal fistula occurred was discharged 19 d after the opration. Conclusion Clinical pathway promotes organized and effective health care, regulates medical behavior of health practitioners, reduces medical costs, and optimizes medical outcomes.

关 键 词：临床路径 阑尾炎 阑尾切除术 

分 类 号：R574.61[医药卫生—消化系统]