临床路径在肾脏病教学中的应用

目的探讨临床路径用于肾脏病临床教学的效果。方法在2010年1月一2012年12月肾内科教学中引入临床路径后，采用平均住院日、人均费用、并发症、抗生素使用百分比及好转率，评价应用临床路径的。肾内科住院患者医疗质量，并与2009年未实施临床路径时作比较。采用内科教研室提供的在我科轮转的八年制临床医学博士生临床考核评分评估教学效果；采用医院质量调查问卷评估患者及医护满意度，并与2009年相同水平的学生比较。数据采用SPSS13．0软件作统计分析，计数资料用r检验．采用百分比描述，计量资料用t检验，用均数±标准差（互±s）表示，以P〈0．05为差异有统计学意义。结果在教学中引入临床路径后，平均住院日由2009年的10．7d下降到2012年的8．7d，药占比由2009年86．6％下降到2012年的33．4％，抗生素使用百分比由2009年79．1％下降到2012年的23．0％；IgA肾病和狼疮肾炎单病种人均住院日和花费均减少；临床考核笔试成绩由（81．0±2．5）分提高到（89．5±2．8）分；患者满意度由94．1％提高到99．0％。结论在临床教学中引入临床路径，有利于提高教学水平，减少不必要的医疗支出，培养医学生的临床思维，有利于培养实用型人才。

Application of clinical pathway in teaching of kidney disease

Objective To evaluate the effects of applying clinical pathway in clinic teaching of kidney diseases. Methods Data of average in-hospital days, costs, percentage of antibiotic drugs, improvement rate and satisfaction of patients who received the clinic pathway in nephrology depart- ment from January 2010 to December 2012 were used to evaluate the quality of clinical pathway and were compared with those of patients not received clinic pathway in 2009. Teaching effects of eight- year clinic medical students whose scores were provided by internal medical teaching section were al- so analyzed. Questionnaire of hospital quality was adopted to assess satisfaction of patients, nurses and doctors and the results were compared with those of 2009 students. All data were analyzed by SPSS 13.0 software. Chi-square test was used for enumeration data and results were expressed as percentage while t test was used for t data and resuhs were expressed as （x ± s）, with P 〈0.05 stand- ing for statistically significant differences. Results After applying clinical pathway, average in-hos- pital days were reduced from 10.7 d in 2009 to 8.7 d in 2012, percentage of medical drugs were de- creased from 86.6% in 2009 to 33.4% in 2012 and percentage of antibiotic drug were reduced from 79.1% to 23.0%. Average in-hospital days and costs of IgA nephropathy and lupus nephritis were de- creased. Satisfaction of patients was increased from 94.1% to 99.0% and scores of students were in- creased from （81.0 ± 2.5） points to （89.5±~ 2.8） points. Conclusions Application of clinical path- way in clinic medical teaching should be encouraged. It can enhance the teaching quality and is help- ful for culturing inno-vative clinic thinking of medical students and cultivate practical medical talents.