前瞻性随机对照多中心研究临床路径对腹股沟疝腹膜前无张力修补术的作用  

Effect of clinical pathway on preperitoneal tension-free inguinal hernia repair: a prospective randomized controlled multi-center study

作　　者：王惠春[1,2] 汤睿[1,2] 林璐[3] 李刚 卢晖 韩江 王炜 周致园[1,2] 顾岩[1,2] 

机构地区：[1]上海交通大学医学院附属第九人民医院普外科 [2]上海交通大学疝与腹壁外科疾病诊治中心,上海200011 [3]上海交通大学医学院附属第九人民医院病案室,上海200011 [4]上海市奉城医院普外科,上海201411 [5]上海市周浦医院普外科,上海201318

出　　处：《外科理论与实践》2014年第1期56-58,共3页Journal of Surgery Concepts & Practice

基　　金：上海市级医院适宜技术联合开发推广应用项目(SHDC12010204)

摘　　要：目的:探讨临床路径对控制腹股沟疝病人住院时间和住院费用的作用。方法:采用前瞻性多中心、随机对照研究方式,对单侧腹股沟疝行开放式腹膜前无张力修补术病人分为临床路径组248例,对照组264例,比较住院时间、住院费用及构成,分析临床路径管理模式在优化腹股沟疝病人资源配置中的作用。结果:临床路径组病人平均住院时间(4.9±1.3)d显著低于对照组(9.1±1.5)d(P<0.01);平均治疗总费用(6 376.5±1 205.8)元,显著低于对照组的(7 715.9±1 853.1)元(P<0.05)。费用构成分析表明,临床路径组病人药费、床位费和检查治疗费较对照组分别下降37%、20%和19%。结论:腹股沟疝临床路径的实施有效规范了腹股沟疝手术的医疗行为,显著降低了病人的住院时间和治疗费用。Objective To explore the effects of clinical pathway on inguinal hernia patients by controlling mean length of stay and cost of hospitalization. Methods The length of stay, cost of hospitalization and expense item were compared. A prospective randomized controlled multi-center study was done with unilateral inguinal hernia patients including 248 case in clinical pathway group and 264 cases in control group, undergoing open pre-peritoneal tension-free inguinal hernia repair. Results The mean hospital length of stay in the clinical pathway group （4.9 ~0.3） day was significantly lower than in the control group（9.1~1.5） day （P〈0.05）. It was shown with the expense items that the mean cost of hospitalization in clinical pathway group （6 376.5~1 205.8）yuan was lower significantly than in control group （7 715.9~ 1 853.1）yuan（P〈0.05 ）. Compared to that in the control group, the cost of pharmacy, bed, examination and treatment in the clinical pathway group decreased 37%, 20% and 19% respectively. Conclusions The clinical pathway can effectively standardize the medical practices, shorten the duration of treatment and reduce the cost of treatment.

关 键 词：腹股沟疝 无张力疝修补术 临床路径 费用 

分 类 号：R656.21[医药卫生—外科学]