普通型手足口病临床路径的制定与应用研究

【目的】评价临床路径在手足口病（普通型）治疗中的实施效果。【方法】根据随机数字表随机分组，将西安市儿童医院手足口病306例患儿随机分成两组，对实施临床路径病例153例（试验组）和同期未实施临床路径的手足口病（普通型）患儿153例病例（对照组）的住院天数、费用指标等临床资料进行比较研究，利用统计学软件对数据进行统计学分析。【结果】试验组和对照组住院天数分别为（4．56±0．45）d ，（6．18±0．63）d ，住院天数平均相差1．6 d ，试验组和对照组治疗费用分别为（2158．57±42．65）元，（4041．34±35．23）元，二者相差1882．77元，试验组住院天数、治疗费、检查费、药物费用、杂费均明显低于对照组，且两组相比较差异均有显著性（P ＜0．01）。试验组的满意度为98．69％（151/153）远远高于对照组81．04％（124/153），且两组相比较差异有显著性（χ2＝5．569，P ＜0．01）；而对临床医生的调查显示临床路径实施可减少工作量。【结论】对普通型手足口病病例实施临床路径可以明显缩短住院天数，降低医疗费用，规范医护主动医疗行为，减少重复劳动，提高工作效率。

Study on the Institution and Application of Clinical Pathway in Common Hand-Foot-Mouth Disease

[Objective]To evaluate the efficacy of clinical pathway in the treatment of common hand ,foot and mouth disease（HFMD） .[Methods] According to random digit table ,305 patients with HFMD in Xi＆#39;an Children＆#39;s hospital were randomly divided into two groups .The days of hospitalization ,medical cost and other clinical data of 153 patients receiv-ing clinical pathway （experiment group） and concurrent 153 patients without receiving clinical pathway （control group） were compared and analyzed statistically .[Results] The days of hospitalization in experimental group and control group were （4 .56 ± 0 .45）d and （6 .18 ± 0 .63）d respectively ,and the average difference was 1 .6d .The medical cost in experi-mental group and control group were （2158 .57 ± 42 .65）yuan and （4041 .34 ± 35 .23）yuan respectively ,and the average difference was 1882 .77yuan .The days of hospitalization ,the cost of treatment ,examination and medicine and other mis-cellaneous expense in experiment group were obviously lower than those in control group ,and there were significant differences between two groups （ P〈0 .01） .The satisfaction degree of experiment group was 98 .69% （151/153） ,which was far higher than that in control group （81 .04% ,124/153） ,and there were significant differences （χ2 =5 .569 ,P 〈0 .01） .The survey of clinical physicians showed that clinical pathway could reduce the work load .[Conclusion] Clinical pathway can obviously shorten the days of hospitalization ,reduce medical cost ,normalize active medical behavior of physi-cians and nurses ,decrease the repeatable labor and improve the work efficiency .