【摘要】 目的探讨临床路径控制儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的医疗费用、缩短住院天数的效果,为儿童OSAHS规范化、标准化和同质化治疗提供依据。方法收集广州市妇女儿童医疗中心实施临床路径前入院的OSAHS患儿为非临床路径组;实施临床路径的OSAHS患儿为临床路径组。临床路径组严格按照临床路径计算机系统设定的程序进行规范化和标准化的治疗;非临床路径组不进入临床路径计算机系统。两组均采用等离子消融术对扁桃体和(或)腺样体进行消融治疗。两组患儿出院后随访时对患儿家属进行综合满意度问卷调查。分析两组患儿的综合满意度、住院总费用、药费和住院天数等指标。结果两组各300例进入分析,两组平均年龄、性别、OSAHS严重程度和手术方式差异均无统计学意义。临床路径组和非临床路径组的综合满意度分别为96.3%和90.7%,差异有统计学意义。临床路径组的平均住院天数、住院总费用、床位费、药费、实验室检查费和治疗费分别为(3.8±1.2)d,(7959±1224)元、(164±52)元、(1001±695)元、(661±84)元和(1586±703)元;非临床路径组分别为(4.4±1.6)d,(8652±1314)元、(189±70)元、(1311±532)元、(730±138)元和(1791±796)元,两组差异均有统计学意义;两组的影像学检查费和手术麻醉费差异均无统计学意义。结论临床路径的实施可提高OSAHS患儿家属的综合满意度,有效降低住院费用、药费和住院天数,有助于OSAHS的规范化、标准化和同质化治疗,值得临床应用推广。更多还原

【Abstract】 Objective To investigate the effect of practicing clinical pathway in controlling medical expenses and reduced hospital stay(day) of hospitalization in children with obstructive sleep apnea hypopnea syndrome(OSAHS),and to support normalization,standardization and homogenization of the treatment to the same disease.Methods Based on the clinical pathway recommended by Ministry of Health,combined with the actual conditions,OSAHS clinical pathway was made and installed into the computer system.All patients were enrolled into two groups,300 cases in each group.One that accepted treatment following clinical pathway was taken as the study group,the cases that not following clinical pathway were grouped as the control group.All of them received coblation-assisted adenotonsillectomy or adenoidectomy.Comprehensive satisfaction survey was carried out after their discharging from the hospital,and the total cost of hospitalization,medication and hostpitalization days were compared between two groups.Results The patients’ average age was 3.5 years,198(66.0%) of them were males,268(89.3%) were with mild to moderate OSAHS,251(83.7%) were treated by adenotonsillectomy,and 49(16.3%) were treated by adenoidectomy in the study group,and the corresponding numbers were 3.6 years old,204(68.0%) cases,276(92%) cases,238(79.3%) cases and 62(20.7%) cases in the control group,respectively.There were no significant differences between two groups,P>0.05.96.3% and 90.7% cases had satisfactory results in the study group and control group.The average length of hospitalization,total hospitalization costs,average expense of accommodation,average medical expense,average laboratory fee,average treatment cost in the study group were(3.8±1.2) days,$(7 959±1 224),$(164±52),$(1 001±695),$(661±84) and $(1 586±703) respectively.They were(4.4±1.6) days,$(8 652±1 314),$(189±70),$(1 311±532),$(730±138),and $(1 792±796) in the control group respectively,with significant differences between the two groups(P<0.01).There were no significant differences in the costs of X-ray and the costs of anesthesia and operation between two groups(P>0.05).Conclusions The application of clinical pathway improves the patient’s satisfaction,reduces the hospitalization costs,medical expenses and length of hospitalization in children with OSAHS.It is worth to promote clinical pathway in clinical application.更多还原