外感高热(社区获得性肺炎,非重症)中医临床路径的实施效果评价  

Evaluation of the Effect of TCM Clinical Pathway of Exogenous Hyperthermia(Community Acquired Pneumonia,Non-severe)

作　　者：窦莉[1] 徐顺娟[1] 指导 奚肇庆[1] Dou Li;Xu Shunjuan;Xi Zhaoqing(Jiangsu Province Hospital of Chinese Medicine,Jiangsu,Nanjing 210029,China)

机构地区：[1]江苏省中医院,江苏南京210029

出　　处：《中国中医急症》2021年第11期1950-1954,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：第二批江苏省名老中医药专家传承工作室建设项目[苏中医科教(2016)6号]。

摘　　要：目的评价外感高热病(社区获得性肺炎,非重症)中医临床路径的实施效果。方法采用回顾性队列研究,评价实施临床路径前后外感高热病证(社区获得性肺炎,非重症)患者的住院费用、住院时间、抗生素使用时间、入院后72h内体温峰值、中医证候积分、临床疗效及影响住院时间的因素等情况。结果本研究路径组病例86例,回顾组病例76例。前者住院平均时间为(9.07±3.29)d,后者为(13.14±9.23)d,住院天数有所下降(P<0.05)。回顾组平均住院费用为(24257.08±20887.27)元,路径组下降至(13650.43±11911.82)元(P<0.05)。回顾组抗生素使用时间为(11.86±7.41)d,入院72h内体温热峰为(38.32±0.68)℃;进入路径治疗后,抗生素使用时间下降至(8.05±2.71)d,体温峰值下降至(38.02±0.56)℃,两者差异具有统计学意义(P<0.05)。路径组临床治疗第5天较回顾组白细胞计数显著下降,且治疗总有效率及中医症状改善均优于回顾组(P<0.05)。通过多因素二元logistic回归分析影响社区获得性肺炎(非重症)患者14d出院的因素,结果显示与年龄大于75岁及合并恶性肿瘤具有相关性(P<0.05)。结论实施外感高热(社区获得性肺炎,非重症)的中医临床路径具有缩短住院天数及抗生素使用时间、减少住院费用、提高临床治疗有效率、改善临床症状等优势,此外年龄及恶性肿瘤病史为延长住院时间的主要因素。Objective:To evaluate the effect of TCM clinical pathway on exogenous hyperthermia(community acquired pneumonia,non-severe).Methods:A retrospective cohort study was conducted to evaluate the hospitalization expenses,length of stay,antibiotic use time,peak temperature within 72 hours after admission,TCM syndrome score,clinical efficacy and influencing factors of patients with exogenous hyperthermia(community-acquired pneumonia,non-severe)before and after the implementation of clinical pathway.Results:There were 86 cases in the pathway group and 76 cases in the retrospective group.The average length of stay of the former was(9.07±3.29)days,while that of the latter was(13.14±9.23)days,indicating the length of stay was decreased(P<0.05).The average hospitalization cost of the retrospective group was(24257.08±20887.27)yuan,while that of the pathway group was(13650.43±11911.82)yuan(P<0.05).In the retrospective group,the duration of antibiotic use was(11.86±7.41)days,and the peak temperature within 72 hours after admission was(38.32±0.68)℃,after entering the pathway treatment,the duration of antibiotic use decreased to(8.05±2.71)days,and the peak temperature decreased to(38.02±0.56)℃(P<0.05).The total effective rate and TCM symptom improvement of the pathway group were better than those of the retrospective group(P<0.05).Multivariate binary logistic regression analysis was used to analyze the influencing factors of 14-day discharge of patients with community-acquired pneumonia(non-severe).The results showed that there was a correlation between age>75 years old and malignant tumor(P<0.05).Conclusion:The implementation of TCM clinical pathway of exogenous hyperthermia(community acquired pneumonia,non-severe)has the advantages of shortening the length of hospital stay and antibiotic use time,reducing hospitalization costs,improving the efficiency of clinical treatment,and improving clinical symptoms.In addition,age and history of malignant tumor are the main factors to prolong the length of hospital stay.

关 键 词：外感高热 社区获得性肺炎 非重症 中医临床路径 回顾性研究 

分 类 号：R563.1[医药卫生—呼吸系统]