临床路径在先天性心脏病介入治疗中的应用评价

目的探讨临床路径（clinical pathway,CP）在先天性心脏病介入封堵术中的应用效果。方法 2006年6月-2012年6月期间成功行先天性心脏病封堵术的患者,包括：动脉导管未闭（PDA）、房间隔缺损（ASD）和室间隔缺损（VSD）;分CP组和非CP组。对两组的平均住院日、住院总费用、并发症发生率、患者满意度及病案质量进行对比分析。结果 599名患者（男203/女396）成功接受先天性心脏病封堵术,CP组408例（PDA126例、ASD166例、VSD116例）,非CP组191例（PDA52例、ASD83例、VSD56例）。CP组各病种平均住院日均明显缩短（P〈0.05）;PDA和ASD患者住院总费用明显下降（P〈0.05）,但VSD总费用无明显降低（P=0.518）。两组整体并发症率无差异（P=0.897）,CP组甲级病案率及患者满意度明显提高（P〈0.001）。结论临床路径是改善先天性心脏病介入封堵术医疗管理质量的有效方法。

Application Evaluation of Clinical Pathway in the Interventional Therapy of Congenital Heart Diseases

Objective To investigate the applicational effects of clinical pathway（CP） in the therapy of interventional closure operation of congenital heart diseases.Methods All patients with congenital heart diseases received interventional closure operation successfully from June 2006 to June 2012 were divided into two groups,CP group and non-CP group,including patent ductus arteriosus（PDA）,atrial septal defect（ASD） and ventricular septal defect（VSD）.To conduct a comparative analysis on items of the two groups,such as the average length of hospital stay,the total cost of hospitalization,rate of complications,satisfaction and quality of medical records.Results 599 patients（203 men and 396 women） received interventional closure operation of congenital heart diseases successfully,including 408 patients in CP group（126 cases of PDA,166 cases of ASD,116 cases of VSD）,191 patients in non-CP group（52 cases of PDA,83 cases of ASD,56 cases of VSD）.The average length of stay of all diseases entities was decreased in the CP group obviously（P 〈0.05 or 0.001）,the total expense of hospitalization were significantly decreased in patients of PDA and ASD（P〈0.05 or 0.001）,but not VSD（P=0.518）.There was no statistical difference in the overall complications rate between the two groups（P=0.897）,and the rate of class A medical records and patients satisfaction was significantly increased in the CP group（P〈0.001）.Conclusion Clinical pathway is an effective method for improving the quality of medical therapy management of interventional closure operation of congenital heart disease.