单纯性肛瘘患者接受括约肌间瘘管结扎术治疗过程中的临床路径管理研究

摘要

目的 自行制定括约肌间瘘管结扎术治疗单纯性肛瘘患者的优化临床路径,观察其临床应用效果.方法 选择2015年3月至2016年1月上海中医药大学附属岳阳中西医结合医院肛肠科就诊的60例单纯性肛瘘患者为研究对象,随机将患者分为两组,每组均30例,均接受括约肌间瘘管结扎术治疗.观察组严格按自行制定的临床路径模型流程进行干预,对照组用传统的临床管理方法.对比两组术后创面疼痛程度、创面愈合时间、住院时间、治疗有效率及创面愈合情况、复发情况.结果 术后第1d、3d、5d、7d观察组创面疼痛评分均显著低于对照组,差异均有统计学意义(均P＜0.01).观察组创面平均愈合天数及住院费用均显著少于对照组,差异均有统计学意义(均P＜ 0.01).两组治疗有效率差异无统计学意义(P＞ 0.01).结论 括约肌间瘘管结扎术治疗单纯性肛瘘的临床路径透明度较高、病人依从性较好、具有规范化的流程,令患者在减轻术后疼痛、促进术后创面愈合及降低住院费用方面获益更多.%objective To optimize the clinical pathway of self ligating sphincter fistula for the treatment of simple anal fistula,and to observe its clinical effect.Methods 60 cases with simple anal fistula hospital from March 2015 to January 2016 were selected as the subject of our study from the department of Anorectal Surgery in Yueyang Integrated Traditional Chinese and Western Medicine hospital and were randomly divided into two groups with 30 cases in each group.All of the patients in the two groups were treated with ligation of intersphincteric fistula.The observation group was intervened stricdy according to self-established clinical pathway,and the control group was treated with traditional clinical management methods.Results The wound pain scores in the first,third,fifth and seventh day after operation of wound pain in the observation group were significandy lower than those in the control group,and the differences were statistically significant (P ＜ 0.01).The average healing days and hospitalization expenses of the observation group were significantly less than those of the control group with a statistically significant difference (P ＜ 0.01).However,there was no obvious difference in the curative effect between the two groups (P ＞ 0.01).Conclusion The clinical pathway has higher transparency,better patient compliance and standardized procedures,which make patients benefit more in alleviating postoperative pain,promoting postoperative wound healing and reducing hospital costs.