慢性心力衰竭中西医结合临床路径多中心实施效果研究  

Effect of Clinical Pathways Based on Integrative Medicine for Patients with Chronic Heart Failure: a Multi-center Research

作　　者：邹旭[1] 潘光明[1] 盛小刚[1] 姚耿圳[1] 朱明军[2] 吴旸[3] 陈晓虎[4] 王永霞[2] 崔杰[3] 陈建东[4] 

机构地区：[1]广东省中医院心血管科,广州510120 [2]河南中医学院第一附属医院心脏中心,郑州450000 [3]北京中医药大学东方医院心内科,北京100078 [4]江苏省中医院心血管内科,南京210029

出　　处：《中国中西医结合杂志》2013年第6期741-746,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家中医药管理局公益性行业科研专项资助项目(No.200707004)

摘　　要：目的评估慢性心力衰竭中西医结合临床路径多中心实施的效益。方法采用非同期历史对照研究与同期临床对照研究相结合的方法,全国4家医院实施临床路径规范化管理后,评估其对患者住院天数、住院费用、临床疗效、患者满意度、生活质量的影响。结果非同期历史对照研究结果表明:路径组较回顾组住院天数明显缩短(12.59天vs18.44天),住院总费用明显降低(9051.90元vs11978.40元),差异有统计学意义(P<0.05);路径组与回顾组心功能疗效比较,路径组显效率和总有效率均高于回顾组(45.60%vs21.90%,96.80%vs86.10%),差异有统计学意义(P<0.01)。同期对照研究表明路径组与常规组的住院天数(11.19天vs13.21天)比较,差异有统计学意义(P<0.05);路径组平均住院总费用低于常规组(8656.80元vs11609.70元),差异有统计学意义(P<0.01);两组中医证候疗效比较,路径组总有效率高于回顾组(97.10%vs93.62%),差异有统计学意义(P<0.05);路径组与常规组心功能疗效比较路径组显效率高于常规组(49.30%vs38.30%),差异有统计学意义(P<0.05);路径组整体满意度高于常规组,差异有统计学意义(P<0.01)。两组患者出院后3个月内的病死率、因心衰发作再次入院率比较,差异无统计学意义(P>0.05),生活质量比较差异有统计学意义(P<0.05)。结论该临床路径能够缩短住院时间,降低住院费用,提高临床疗效,提高患者生活质量,提高患者满意度,可供全国推广应用。关键词慢性心力衰竭;Objective To assess a multi-center study effectiveness of clinical pathways based on integrative medicine （IM） for chronic heart failure （CHF） patients. Methods A combined method of historical control study and clinical study on concurrent control was used. After the standard manage- ment for clinical pathways was carried out in four hospitals at home, the effects on hospitalization days, medical expenses, clinical efficacy, patient satisfaction, and quality of life were assessed. Results Re- suits of non-concurrent historical control study showed that： the hospital stay was significantly shorter in the pathways group than in the retrospective group （12.59 days vs 18.44 days）, and the total cost of hospitalization was significantly reduced in the pathways group （￥9 051.90 vs ￥11 978.40）, showing statistical difference （P 〈0.01 ）. Moreover, the effect on the heart function was better in the pathways group than in the retrospective group （the markedly effective rate= 45.60% vs 21.90%; the total effec- tive rate. 96.80% vs 86.10%）, showing statistical difference （P 〈0.01 ）. Results of clinical study on concurrent control showed that the hospital stay was significantly shorter in the pathways group than inthe control group （11.19 days vs 13.21 days）, showing statistical difference （P 〈0.05）. The average to- tal cost of hospitalization was significantly lower in the pathways group than in the control group （ ￥8 656.80 vs ￥11 609.70）, showing statistical difference （P 〈0.01 ）. As for clinical efficacy of Chi- nese medical syndrome, the total effective rate was higher in the pathways group than in the control group （97.10% vs 93.62%）, showing statistical difference （P 〈0.05）. The markedly effective rate of heart function was better in the pathways group than in the control group, showing statistical difference （49.30% vs 38.30%, P 〈0.05）. The overall satisfaction was higher in the pathways group than in the conventional group （P 〈0.01 ）.

关 键 词：慢性心力衰竭 临床路径 

分 类 号：R541.6[医药卫生—心血管疾病]