【作者】 陈林；

【导师】 李振宇；

【作者基本信息】 广州中医药大学 ， 中医骨伤科学（专业学位）， 2015， 硕士

【摘要】 目的：探讨实施腰椎间盘突出症临床路径对腰椎间盘突出症患者在疗效,平均住院日,住院费用,病人满意度等方面的影响。方法：采用前瞻性随机对照研究,研究组为广东省中医院珠海医院骨二科2013年9月至2014年9月符合腰椎间盘突出症临床路径条件并经随机分配入径者(标记为A组)。对照组为广东省中医院珠海医院骨二科2013年9月至2014年9月符合腰椎间盘突出症临床路径条件但随机分配为不经临床路径干预的患者(标记为B组)。收集每个病例的临床治疗前后JOA评分,平均住院日,住院总费用及其分项费用及研究过程中变异情况的数据,分别进行统计学分析比较,得出结论。结果：1.效率指标方面：平均住院日：A组为8.14±2.72天,B组为11.00±4.35天；平均住院日具有显著性差异(P<0.05)。2.经济指标方面：两组患者住院期间总费用：A组为5239.77±1496.54元,B组(为6075.67±2511.65元；中成药方面：A组为1122.66±469.20元,B组为1193.11±759.22元；西药费用：A组为281.23±241.29元,B组为471.27±611.01元；住院期间检查费用：A组为900.80±699.15元,B组为947.44±706.00元；住院期间治疗费用：A组为1224.05±701.20元,B组为1564.45±1017.36元；经过比较得出临床路径组在降低西药费用、治疗费用有显著性差异(P<0.05),通过最后的比较表现出实行临床路径组的住院总费用更低。3.临床指标方面：两组临床治愈率：A组为100%,B组为95%；入院时JOA评分：A组为1017.36±1.49分,B组为14.35±1.53分；出院时JOA评分：A组(临床路径组)为25.45±1.26分,B组(非临床路径组)为25.42±1.79分；出院时症状改善率：A组为76.12±8.93%,B组为75.41±11.65%；出院时症状改善指数：A组为11.48±1.97,B组为11.07±2.19；经过比较得出临床路径组和非临床路径组在出院时JOA评分无统计学差异(P>0.05),两组患者均能得到相同的症状改善。4.研究过程变异情况的比较方面：临床路径组有4名患者因特殊原因退出临床路径,但均与临床路径实施无关,两组过程中均无严重临床事故发生。结论：执行腰椎间盘突出症临床路径可以提高管理效率,减少临床差错,可在保证临床疗效的情况下有效缩短患者住院时间,提高床位周转率等使医疗资源利用率的到提升；并可有效降低总住院费用,减轻患者医疗负担。更多还原

【Abstract】 ObjectivesTo discuss the clinical effect,average hospitalization date,patient satisfaction, hospitalization expenseaffected by clinical pathway of lumbar disc disease TCM treatment and rehabilitation.MethodsSelecting the outpatients and inpatients of orthopedic in Traditional Chinese Medical Hospital of Guangdong Province ZhuHai branch by instandands and outstandards. Using randomiaed controled study method,120 patients randomly divided into 2 groups according to 1:1 ratio. The experimental group was given clinical pathway of lumbar disc disease TCM treatment and rehabilitation (sign:A). the control group was given normal treatment (sign:B). Collect the before arid after treatment JOA score and rate of the improved JOA score, average length of hospital stay,The hospital total cost and general expenses, and then comparing by statistical analysis.Results1. Efficiency index.-average hospitalization date:groupA:8.14±2.72d, groupB:11.00±4.35d; Differences are statistically significant (P<0.05).2.economic indicators:The total cost during hospitalization:groupA: 5239.77±1496.54yuan,groupB:6075.67±2511.65yuan;Chinese patent medicine: groupA:1122.66±469.20yuan, groupB:1193.11±759.22yuan;western medicine expenses:groupA:281.23±241.29yuan,groupB:471.27±611. Olyuan;examination fee:groupA:281.23±241.29yuan, groupB:947.44±706.00yuan; Treatment costs:1224.05±701.20yuan, groupB:1564.45±1017.36yuan; the differences of western medicine expenses, total cost during hospitalization and Treatment costs are statistically significant(P<0.05).3. clinical index:clinical cure rate:groupA:100%, groupB:95%; JOA score onadmition hospital:groupA:1017.36±1.49, groupB:14.35±1.53; JOA score on Discharged from hospital:groupA:25.45±1.26, group B:25.42 ±1.79。Symptom recovery rate:group A:76.12±8.93%, group B:75.41 ±11.65%; Symptom recovery index:group A:11.48±1.97, group B:11.07 ±2.19。The differences of JOA score are no statistically significant (P>0.05).4. analysis of variability:4 patients exit the clinical pathway but nothing to do with carry out of clinical pathway and there is no significant accident both groups.ConclusionThe practice of Clinical pathway can improved management efficiency, decline the clinical mistake, shorten the length of hospital stay with ensure clinical efficacy,higher the utilization of health resource by improve bed rotation rate,and reduce the financial burden on patients medical.更多还原