肛瘘切除术临床路径研究及安全性评价

目的:制定低位单纯性肛瘘诊治过程中的最优化、最佳的临床路径,规范低位单纯性肛瘘的医疗服务与管理模式。方法:根据2006年《肛瘘诊治指南》的诊断和排除标准,两个中心共纳入病例180例。180例病例随机单盲分为两组(每组90例):试验组和对照组。试验组严格按临床路径模型实施措施进行干预,对照组用传统的诊治方案和护理措施进行治疗。结果:试验组平均住院费用(3331.26元±341.94)元,平均住院时间(11.59±1.98)天,患者及家属满意度(99.68±0.91)%;对照组平均住院费用(4154.77±501.55)元,平均住院时间(18.94±2.94)天,患者及家属满意度(87.67±4.00)%。两组均无术后感染和并发症及后遗症发生,无不良事件和实验室检查结果异常。结论:我们认为肛瘘切除术的临床路径具有良好的透明度、规范化的流程、良好的病人依从、有效地提高肛瘘的医疗质量,降低了住院费用,缩短了住院时间,提高了患者及家属满意度,而且安全性高,从而减少医疗缺陷,降低医疗成本,改善医患关系,和谐医疗环境,在基层医院在肛瘘的诊疗过程中有应用推广价值。

Research and Safety Evaluation of Clinical Pathway of Anal Fistulectomy

Objective:To establish the optimization and the best clinical pathway in the diagnoses and treatment of the low and simple anal fistula,and to standardize the medical service and the management mode of the low set and simple anal fistula.Method:According to the diagnosis and exclusion criterion published in The Handbook of Diagnoses and Treatment for Anal Fistula,which published in 2006.180 patients were brought into two centers.180 patients were assigned to 2 groups by the randomized,single blind way:treatment group and control group.90 patients in the treatment group were intervened in accordance with the rigorous clinical pathway(flow graph),while the 90 patients in the control group were treated with the traditional diagnosis and treatment way and nursing intervention.Results:The average cost of hospitalization of the patients in the treatment group was(3331.26±341.94)RMB and the average length of stay was(11.59±1.98)D,the degree of satisfaction and the dependence in a family was(99.68±0.91)%;the average cost of hospitalization of the patients who in the control group was(4154.77±501.55)RMB and the average length of stay was(18.94±2.94)D,the degree of satisfaction and the dependence in a family was(87.6±4.00)%.Both had no postoperative infection,sequelae and no harmful incidence and laboratory examination abnormality.Conclusion:We consider that the anal fistulectomy has the favourable diaphaneity,normalized flowsheet and upstanding patient compliance.It can elevate the treatment quality,reduce the cost of hospitalization,shorten the length of stay and increase the degree of satisfaction of the patient and their family.Moreover it has high reliability and can reduce the flaw of medical treatment,reduce medical costs,improve the doctor-patient relationship and harmonize the medical treatment environment.To sum up,the clinical pathway has application value in the primary hospital.