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目的:针对消化内科的几个疾病临床路径变异的原因及对策进行分析。方法:对我院2015年1月至2016年7月接受治疗的70例临床路径患者进行选取,其中42例患者出现临床路径变异状况,对患者临床路径变异的原因进行分析,并制定出有效的控制措施。结果:通过临床路径的实施,出现了不同程度变异的患者共计42例,总变异率为60%,如果通过变异类型的对比进行对其分类,其中38%是由患者自身疾病的原因导致的;33%是由患者的主观因素导致的;22%是由医生导致的;剩余的7%是由医院导致的。如果对变异的管理产生的困难程度分类,疾病原因是不可控的,占总比例的38%,55%是由于患者的主观因素和医生的治疗导致的,是可以进行控制的。其中存在28例通过大肠息肉摘除术治疗的患者,其出院的平均时间为(4.05±0.25)天,与临床路径所规定的时间存在明显差异(P<0.05),具有统计学意义。结论:如果变异情况是由患者的主观因素和医生的治疗引起的,则能够通过治疗使病情得到良好的控制。过度的进行检查和使用药物的不合理性是导致变异的主要因素,所以,适当的进行检查和按照规范用药能够有效的对变异情况进行控制。
Objective: To analyze the causes of clinical pathological variation of several diseases in gastroenterology and its countermeasures. Methods: A total of 70 clinical pathways were selected from January 2015 to July 2016 in our hospital. Among them, 42 patients had clinical pathological changes, and the causes of clinical pathological changes were analyzed and effective Control measures. Results: A total of 42 patients with varying degrees of mutation were found in the clinical pathway. The total mutation rate was 60%. If categorized by the type of mutation, 38% of them were caused by the patient’s own disease. 33% were caused by patient subjective factors; 22% were caused by doctors; and the remaining 7% were hospital-induced. If the classification of the degree of difficulty in the management of the mutation, the cause of the disease is uncontrollable, accounting for 38% of the total, 55% due to the patient’s subjective factors and the treatment of the doctor can be controlled. There were 28 patients who underwent polypectomy for colorectal polyps. The mean discharge time was (4.05 ± 0.25) days, which was significantly different from the time required by clinical pathology (P <0.05), which was statistically significant. Conclusion: If the variation is caused by the patient’s subjective factors and the doctor’s treatment, the condition can be well controlled through the treatment. Excessive inspection and use of drugs unreasonable is the main factor leading to variation, therefore, appropriate inspection and follow the standard medication can effectively control the variation.