临床路径管理在肾结石患者中的应用及变异分析

摘要

Objective To investigate the priority of clinical pathway in patients with renal caculi introduced by percutanous nephrolithotomy with holum laser and analysis the variation during this procedure. Methods 180 patients with renal caculi, who fit clinical pathway management, are as the CP group and 196 patients with the same condition are as the control group. Average hospitalization length, the rate of caculi-free postoperation, and expenses are compared between the two groups. Variation in CP management is also analyzed. Results The ratio of clinical path group, which fits clinical pathway management, is 41.67％. 5833％ cases variate from CP management with the main reason of different recognition of doctors and patients. There are differences in average hospitalization length and degree of satisfaction in patients (P＜005). There is no difference in the percentage of patients with no renal caculi after operation, average length of stay, and medicine in hospitalization costs between two groups. Conclusion CP management will behefit patients with renal caculi in average hospitalization length, medical costs and degree of patients satisfaction. The core of CP management currently is to enhance the recognition in doctors and patients.%目的探讨临床路径(CP)管理在经皮肾镜钬激光碎石术治疗肾结石患者中的应用及变异分析.方法 180例符合CP管理入径标准者,按既定肾结石CP管理流程进行诊疗操作(CP组).将此前196例非CP管理患者作为对照组,对比2组间平均住院日、术后无石率、平均住院花费以及其中药品费用所占的百分比、患者出院满意度评分等量化指标的差异,并对其中变异情况进行分析.结果 CP组入径率41.67%,变异率达58.33%,导致变异的主要原因在于医、患对CP管理流程的认识偏差;CP组在平均住院日、平均住院花费及患者满意度优于对照组,具有统计学差异(P＜0.05).术后无石率、平均住院费用、药品所占住院费用百分比2组未见统计学差异.结论 CP管理可有效缩短PCNL手术患者平均住院日,降低医疗费用、提高患者满意度.加强CP管理的医患教育是推行CP管理的关键.