临床路径在计划性剖宫产中的应用

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1、临床路径在计划性剖宫产中的应用李丹，朱义保，赵菲，万凌玲，郑九生，刘淮(江西省妇幼保健院，江西南昌330006)【摘要】目的:探讨卫生部试行的临床路径管理在我院计划性剖宫产中的应用效果。方法:选取185例已实施临床路径管理的计划性剖宫产孕妇(路径组)和96例未实施临床路径管理的计划性剖宫产孕妇(对照组)，对两组孕妇的住院天数、各种住院费用、各项指标的变异系数和构成比，以及患者的满意度和术后并发症等指标进行综合比较分析。结果:路径组住院天数比对照组缩短，差异有高度统计学意义(P=0.00)，但住院总费用两组比较，差异无统计学意义(P=0.19);对于住院总费用的构成变化，路径组药费下降，但治疗

2、费增加，两组间的药费和治疗费比较，差异均有统计学意义(P＜0.05);路径组变异系数波动总体较对照组小，患者满意度有所提高，但术后并发症率无明显改变。结论:临床路径应用于我院计划性剖宫产起到了规范医疗行为的作用。【关键词】临床路径;计划性剖宫产;医疗费用;变异系数;满意度中图分类号:R719.8文献标识码:AApplicationofClinicalPathwayinScheduledCaesareanSectionLIDan，ZHUYibao，ZHAOFei，etal(JiangxiMaternalandChildCareHospital，NanchangJiangxi330006，Chi

3、na)Correspondingauthor:LIUHuai【Abstract】Objective:ToevaluatetheeffectofclinicalpathwaytriedoutbytheMinistryofPublicHealthinthescheduledcaesareansection．Methods:185caseswithscheduledcaesareansectionwereselectedclini-calpathway(Pathwaygroup)．96caseswereselectednonclinicalpathwayascontrolgroup．Thetime

4、ofhospitalization，variousmedicalcarecosts，coefficientofvariationandconstituentratioofdifferentparame-ters，andpatient’ssatisfactiondegreeaswellastheircomplicationsafteroperationwereanalyzedandcom-paredbetweenthetwogroups．Results:Thetimeofhospitalizationinpathwaygroupwasshorterthanthatincontrolgroup．

5、Therewasstatisticaldifferencebetweenthem(P=0.00)．Therewasnostatisticaldifferencebetweenthemaboutmedicalcarecosts(P=0.19)．Inpathwaygroup，theconstituentratioofmedicalcarecostwaschanged．Thedrugcostsweredecreased，butthetreatmentcostswereincreased．Therewassta-tisticaldifferenceamongtwogroupsaboutdrugand

6、treatmentcosts(P＜0.05)．Comparedtocontrolgroup，thecoefficientofvariationinpathwaygroupwassmallerthancontrolgroup，andthepatient’ssatisfactorydegreewasincreased，buttherewasnoobviouschangesaboutcomplicationsafteroperation．Conclusions:Clinicalpathwayappliedinourhospitalstandardizesmedicaltreatmentinthes

7、cheduledcaesareansection．【Keywords】Clinicalpathway;Scheduledcaesareansection;Medicalcarecost;Coefficientofvariation;Satisfactiondegree为进一步深化医疗改革，2010年初，卫生部在全国各大医院推出了临床路径(clinicalpathway)管理试点工作，旨在探讨一种“规范医疗行为