临床路径在急性ST段抬高型心肌梗死治疗中的应用  

Study on the application of clinical pathway in patients with acute ST elevated myocardial infarction

作　　者：陈超峰[1,2] 袁争百 苏振琪 韩宏华[2] 

机构地区：[1]江苏省徐州市第三人民医院心内科,221000 [2]淮北矿工总医院心内科,安徽淮北235000

出　　处：《蚌埠医学院学报》2015年第1期56-58,共3页Journal of Bengbu Medical College

摘　　要：目的:评价急性ST段抬高型心肌梗死(STEMI)患者应用临床路径的可行性。方法:选择确诊STEMI并于发病后12 h内接受急诊经皮冠状动脉介入治疗的患者61例,根据患者不同主观因素按不同的临床路径分为快路径组(由急诊室直接入导管室)和慢路径组(由急诊室入心内科病房或冠心病监护单元,再入导管室)。采用焦虑自评量表、抑郁自评量表测试患者入院时及出院时的心理变化,观察2组患者住院费用、住院时间、满意度及心理变化。出院时采用满意度调查表进行满意度调查。结果:快路径组住院总费用、西药费、住院时间均明显低于慢路径组(P<0.01),但其日均费用高于慢路径组(P<0.01);快路径组出院前焦虑自评量表、抑郁自评量表积分均较入院时和慢路径组降低(P<0.01和P<0.05),患者满意率高于慢路径组(P<0.01)。结论:临床路径应用于STEMI可明显降低医疗费用,缩短住院时间,减少患者心理问题,提高患者的满意度,是一种行之有效、值得推广的服务管理模式。Objective： To evaluate the practicability of application of clinical pathway in patients with acute ST-elevation myocardial infarction（ STEMI）. Methods： Sixty-one cases of STEMI within 12 h of symptom onset were received primary percutaneous coronary intervention. All patients were randomly divided into two groups,35 cases were brought directly to catheterization laboratory（ rapid group）,and 26 cases were admitted to the coronary care unit or cardiac ward firstly,then transferred to the catheterization laboratory（ slow group）. Hospitalization expenses,hospitalization time,the psychological changes of the subjects,patients＇ satisfaction degree were recorded. The psychological changes of the subjects were determined by self-rating anxiety scale（ SAS） and self-rating depression scale（ SDS）. Results： In rapid group,the total hospitalization expenses,the western medicine expenses,and the hospitalization time were significantly shorter than in slow group（ P〈0. 01）; but the hospitalization expenses per day was higher than in slow group（ P〈0. 01）.SAS and SDS indices were decreased significantly in rapid group compared with those in slow group（ P〈0. 01 and P〈0. 05）. Patients were more satisfied with their treatments in rapid group（ P〈0. 01）. Conclusions： Application of clinical pathway in the STEMI patients can obviously decrease expenses,hospitalization time and psychological problems. And it can increase the satisfaction degree of patients. It is a new and effective management mode.

关 键 词：心肌梗死 临床路径 

分 类 号：R542.22[医药卫生—心血管疾病]