中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2013年
10期
793-797
,共5页
杨洋%尹丽娟%彭东红%黄英%代继宏
楊洋%尹麗娟%彭東紅%黃英%代繼宏
양양%윤려연%팽동홍%황영%대계굉
临床路径%肺炎%儿童%抗生素类
臨床路徑%肺炎%兒童%抗生素類
림상로경%폐염%인동%항생소류
Critical pathways%Pneumonia%Child%Antibiotics
目的 探讨临床路径管理对儿童肺炎的管理效果.方法 收集重庆医科大学附属儿童医院呼吸二病房2011年1月至2012年12月期间住院并诊断为支气管肺炎、毛细支气管炎、支原体肺炎患儿资料,根据是否实行临床路径管理分为路径管理组(405例,年龄1个月～15岁)和非路径管理组(503例,年龄1个月～11岁),评价两组住院天数、住院费用、临床疗效以及抗生素使用情况.结果 路径管理组支气管肺炎、毛细支气管炎患儿平均住院天数分别为(6.1±1.6)d、(6.2±1.5)d,非路径管理组为(7.2±1.9)d、(7.3±1.5)d,差异有统计学意义(P =0.000),两组支原体肺炎患儿住院天数[(6.9±1.8)d vs.(7.7±2.5)d]比较差异无统计学意义(P =0.198)；支气管肺炎、毛细支气管炎、支原体肺炎三个病种检验费路径管理组较非路径管理组稍高,其余各费用均较非路径管理组低.路径管理组和非路径管理组中支气管肺炎、毛细支气管炎和支原体肺炎总费用分别为(4609±1225)元vs.(5629±1813)元、(5006±1250)元vs.(5686±1337)元、(4946±1259)元vs.(6488±3032)元,路径管理组均低于非路径管理组(P＜0.05).抗生素使用率[(70.9％vs.99.4％)、(45.7％vs.93.4％)、(96.2％vs.100.0％)]路径管理组均低于非路径管理组(P＜0.05).抗生素使用天数、联用情况及抗生素使用级别在路径管理组明显改善(P＜0.01).两组间临床疗效及30 d内同一疾病非计划再入院差异无统计学意义(P＞0.05).结论 临床路径管理在规范医疗行为的同时降低医疗成本,避免了过度用药、检查及治疗,特别是在抗生素管理方面突显成效,值得临床推广应用.
目的 探討臨床路徑管理對兒童肺炎的管理效果.方法 收集重慶醫科大學附屬兒童醫院呼吸二病房2011年1月至2012年12月期間住院併診斷為支氣管肺炎、毛細支氣管炎、支原體肺炎患兒資料,根據是否實行臨床路徑管理分為路徑管理組(405例,年齡1箇月～15歲)和非路徑管理組(503例,年齡1箇月～11歲),評價兩組住院天數、住院費用、臨床療效以及抗生素使用情況.結果 路徑管理組支氣管肺炎、毛細支氣管炎患兒平均住院天數分彆為(6.1±1.6)d、(6.2±1.5)d,非路徑管理組為(7.2±1.9)d、(7.3±1.5)d,差異有統計學意義(P =0.000),兩組支原體肺炎患兒住院天數[(6.9±1.8)d vs.(7.7±2.5)d]比較差異無統計學意義(P =0.198)；支氣管肺炎、毛細支氣管炎、支原體肺炎三箇病種檢驗費路徑管理組較非路徑管理組稍高,其餘各費用均較非路徑管理組低.路徑管理組和非路徑管理組中支氣管肺炎、毛細支氣管炎和支原體肺炎總費用分彆為(4609±1225)元vs.(5629±1813)元、(5006±1250)元vs.(5686±1337)元、(4946±1259)元vs.(6488±3032)元,路徑管理組均低于非路徑管理組(P＜0.05).抗生素使用率[(70.9％vs.99.4％)、(45.7％vs.93.4％)、(96.2％vs.100.0％)]路徑管理組均低于非路徑管理組(P＜0.05).抗生素使用天數、聯用情況及抗生素使用級彆在路徑管理組明顯改善(P＜0.01).兩組間臨床療效及30 d內同一疾病非計劃再入院差異無統計學意義(P＞0.05).結論 臨床路徑管理在規範醫療行為的同時降低醫療成本,避免瞭過度用藥、檢查及治療,特彆是在抗生素管理方麵突顯成效,值得臨床推廣應用.
목적 탐토림상로경관리대인동폐염적관리효과.방법 수집중경의과대학부속인동의원호흡이병방2011년1월지2012년12월기간주원병진단위지기관폐염、모세지기관염、지원체폐염환인자료,근거시부실행림상로경관리분위로경관리조(405례,년령1개월～15세)화비로경관리조(503례,년령1개월～11세),평개량조주원천수、주원비용、림상료효이급항생소사용정황.결과 로경관리조지기관폐염、모세지기관염환인평균주원천수분별위(6.1±1.6)d、(6.2±1.5)d,비로경관리조위(7.2±1.9)d、(7.3±1.5)d,차이유통계학의의(P =0.000),량조지원체폐염환인주원천수[(6.9±1.8)d vs.(7.7±2.5)d]비교차이무통계학의의(P =0.198)；지기관폐염、모세지기관염、지원체폐염삼개병충검험비로경관리조교비로경관리조초고,기여각비용균교비로경관리조저.로경관리조화비로경관리조중지기관폐염、모세지기관염화지원체폐염총비용분별위(4609±1225)원vs.(5629±1813)원、(5006±1250)원vs.(5686±1337)원、(4946±1259)원vs.(6488±3032)원,로경관리조균저우비로경관리조(P＜0.05).항생소사용솔[(70.9％vs.99.4％)、(45.7％vs.93.4％)、(96.2％vs.100.0％)]로경관리조균저우비로경관리조(P＜0.05).항생소사용천수、련용정황급항생소사용급별재로경관리조명현개선(P＜0.01).량조간림상료효급30 d내동일질병비계화재입원차이무통계학의의(P＞0.05).결론 림상로경관리재규범의료행위적동시강저의료성본,피면료과도용약、검사급치료,특별시재항생소관리방면돌현성효,치득림상추엄응용.
Objective To investigate effect of clinical pathway management on pediatric pneumonia.Method Data were colleted from children hospitalizated with bronchial pneumonia,bronchiolitis,mycoplasma pneumonia in Center of Respiratory Disorders in Children's Hospital of Chongqing Medical University from January 2011 toDecember 2012.According to implement of clinical pathway management,all patients were divided into pathway management group (n =405) and non-pathway management group (n =503).Length of stay,costs of hospitalization,clinical effect and use of antibiotics were compared in these two groups.Result In pathway management group,average length of stay of children with bronchial pneumonia and bronchiolitis was (6.1 ± 1.6) d and (6.2 ± 1.5) d respectively.While in non-pathway management group,length of stay was (7.2 ± 1.9) d and (7.3 ± 1.5) d (P =0.000).There was no significant difference in length of stay between these two groups of children with mycoplasma pneumonia [(6.9± 1.8) d vs.(7.7 ± 2.5) d] (P =0.198).Costs of auxiliary tests in pathway managcment group was slightly higher than that in non-pathway management group.While other costs in pathway management group were significantly lower than those in non-pathway management group.Total costs of hospitalization of patients with these three diseases in pathway management group and non-pathway management group were ￥ (4609 ± 1225) vs ￥ (5629 ± 1813),￥ (5006 ± 1250) vs.￥ (5686 ± 1337),￥ (4946 ± 1259) vs.￥ (6488 ± 3032) respectively.There was a significant difference (P ＜ 0.05).Percentages of antibiotics use in two groups were 70.9％ vs.99.4％,45.7％ vs.93.4％ and 96.2％ vs.100.0％.Antibiotics related indicators such as mean number of day of use,ratio of combination and grade of antibiotics were significantly higher in pathway management group compared to non-pathway management group (P ＜ 0.01).There was no significant difference in other indicators like clinical effect and unscheduled readmission in 30 days between two groups (P ＞ 0.05).Conclusion Clinical pathway management can regulate medical behaviors through reduction of medical costs,avoidance of excessive laboratory tests and therapy,and regulation of antibiotic use.
