临床路径在中国慢性阻塞性肺疾病患者中应用效果的Meta分析

摘要

Objective To evaluate the application effect of clinical pathway for patients with chronic obstructive pulmonary disease (COPD) in China .Method The application effect of clinical pathway for patients with chronic ob‐structive pulmonary disease was collected using computer to search CNKI ,CBM ,Wanfang data base and manual in‐spection .Cochrane systematic review's manual 5 .1 .0 quality evaluation criteria are included to evaluate the study by RevMan5 .0 Meta‐analysis software .Result There were 9 references included eventually ,a total of 930 patients inclu‐ding 474 cases of observation group and 456 control group .(1) Randomized model for COPD patients in hospital costs [MD= -0 .38 ,95% CI (-0 .50 , -0 .26),Z= 6 .23 ,P< 0 .00001] and length of hospital stay [MD=-4 .52 ,95% CI (-6 .20 ,-2 .84) ,Z=5 .28 ,P<0 .00001] clinical pathway of the application to statistical analy‐sis .There was significant difference .(2) Descriptive analysis was used in clinical pathway for COPD patients'hospi‐talized satisfaction and related knowledge of the effect of the application ,five studies showed clinically effective way to increase domestic COPD patients hospitalized satisfaction (P<0 .05) ,one study showed no significant difference (P>0 .05);5 clinical studies showed a statistically significant way (P< 0 .05) for patients with COPD related knowledge mastery domestic applications .(3) Fixed model of clinical pathways for reducing complications in pa‐tients with COPD application analysis ,the results show :[MD= 0 .31 ,95% CI (0 .15 ,0 .66) , Z= 3 .07 , P=0 .002] ,there was significant difference (P<0 .01) .Conclusion Studies have shown that the clinical pathway as a standardized model of health care services used for COPD in China can reduce hospital costs ,the length of stay and complications ,and can improve patient satisfaction and related knowledge degree to a certain extent .The depth and breadth of its application in the clinical work of medical institutions in the country should be further promoted .%目的：评价临床路径在中国慢性阻塞性肺疾病患者中的应用效果。方法计算机检索中国期刊全文数据库（CNKI）、万方数据资源系统、中国生物医学文献数据库（CBM ）等数据库，结合手工查阅临床路径在中国COPD患者中的应用效果的相关文献，检索时间为建库至2014年12月。采用Cochrane系统评价员手册5．1．0质量评价标准对所纳入的研究进行评价，通过RevMan5．0软件进行Meta分析。结果最终纳入随机对照实验文献9篇，共930例患者，其中观察组474例，对照组456例。（1）采用随机模型对临床路径在COPD病患者住院费用[MD＝－0．38，95％ CI（－0．50，－0．26），Z＝6．23，P＜0．00001]及住院天数[MD＝－4．52，95％ CI（－6．20，－2．84），Z＝5．28，P＜0．00001]中的应用进行统计分析，差异具有统计学意义。（2）临床路径在COPD患者住院满意度及相关知识掌握度的应用效果采用描述性分析，5项研究结果显示临床路能有效提高国内COPD患者的住院满意度（P＜0．05），1项研究结果显示无统计学差异（P＞0．05）；5项研究结果显示临床路在国内COPD患者的相关知识掌握的应用中具有统计学意义（P＜0．05）。（3）采用固定模型对临床路径减少COPD患者并发症中的应用进行分析，结果显示：[MD＝0．31，95％ CI（0．15，0．66），Z＝3．07，P＝0．002]，差异具有统计学意义（P＜0．01）。结论研究表明，临床路径作为一种标准化的医疗护理服务模式应用于中国慢性阻塞性肺疾病患者中，能够降低住院费用、减少住院天数及并发症、一定程度上能提高患者满意度及相关知识掌握度，其应用深度和广度在国内医疗机构的临床工作中应得到进一步推广。