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目的探索临床路径在成人急性阑尾炎手术中的应用,是否在经济和安全上获益。方法我们研究110例16岁以上病理诊断为急性阑尾炎的病例,分为2组:应用临床路径组(C1inical Pathway Group简称CP组,n=55)和对照组(Historical Control Prepathway Group简称HC组n=55)。CP组采用急性阑尾炎手术临床路径进行管理,HC组则采用传统方式进行诊断治疗。对年龄、性别、病理类型,住院时间、住院费用、抗生素使用、并发症的发生率进行比较。结果二组在年龄(P=0.98)、性别(P=0.41)、病理类型(P=0.91)均无显著差异,主要并发症的发生例数下降(1比3),但无显著差异(P=0.09)。抗生素使用天数下降(3.69比4.05),有显著差异(P=0.03);平均住院时间明显缩短(4.20对4.78)(P=0.006);住院费用下降(2761.45元对3000.34元)(P=0.126)。结论在急性阑尾炎手术的管理中,临床路径的应用有效而安全,它不仅降低住院时间、住院费用,还能降低应用抗生素的使用天数,而且不增加主要并发症的发生率。
Objective To explore whether clinical pathways can be used in the treatment of acute appendicitis in adults and benefit from economic and security benefits. Methods We studied 110 patients with pathologic diagnosis of acute appendicitis over the age of 16 and divided them into two groups: group with clinical pathways (CP group, n = 55) and control group (group with control n = 55). The CP group was treated with clinical pathology of acute appendicitis and the HC group was diagnosed and treated by traditional methods. The age, gender, pathological type, length of stay, cost of hospitalization, antibiotic use, complication rates were compared. Results There were no significant differences in age (P = 0.98), gender (P = 0.41), pathological type (P = 0.91), and the incidence of major complications decreased by 1 to 3 (P = 0.09). (P = 0.006); hospitalization costs decreased (2761.45 yuan vs 3000.34 yuan) (P = 0.126); the average hospitalization time was significantly shorter (P = 0.006) . Conclusions In the management of acute appendicitis, the clinical pathway is effective and safe. It not only reduces the length of hospital stay and hospitalization, but also reduces the number of antibiotics used days and does not increase the incidence of major complications.