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目的探讨食管癌患者临床路径中的变异因素及其针对性改进式干预的效果。方法选取208例食管癌根治术患者为研究对象,将2012年1月至6月的104例患者作为对照组,将2012年7月至12月的104例患者作为观察组。对照组给予常规临床路径护理干预,观察组在总结对照组临床路径变异的基础上,对临床路径进行改进后实施,比较两组患者干预效果的差异。结果对照组104例患者,其中84例发生临床路径变异,发生率为80.77%,正性变异55例(52.88%),负性变异29例(27.88%),未变异20例(19.23%)。在变异因素中,医务人员导致的变异最多,为34例(40.48%);来自患者24例(28.57%);来自医院管理系统26例(30.95%)。临床路径改进后实施干预的观察组,其住院天数和总治疗费用均低于对照组,医疗护理质量评分和患者对护理质量满意度(97.12%vs 74.04%)均高于对照组,差异均有统计学意义(P<0.05,P<0.01)。结论在对食管癌患者临床路径变异因素进行总结的基础上,实施食管癌临床护理路径的针对性改进,改进后的护理干预效果明显提高,减少了患者住院时间和费用,提高了护理质量和患者满意度,促进了患者的康复。
Objective To investigate the variation of clinical pathways in patients with esophageal cancer and the effect of targeted improvement intervention. Methods A total of 208 esophageal cancer patients undergoing radical resection were selected as the study subjects. One hundred and forty-four patients from January 2012 to June 2012 were selected as the control group and 104 patients from July 2012 to December 2012 as the observation group. The control group was given routine clinical nursing intervention. On the basis of summing up the clinical pathological variation in the control group, the observation group improved the clinical pathology and compared the difference in intervention effect between the two groups. Results Among the 104 patients in control group, 84 cases had clinical pathological changes, the incidence was 80.77%, 55 positive cases (52.88%), 29 negative cases (27.88%) and 20 cases (19.23%) unvaried cases. Among the variation factors, medical staff led to the most variation in 34 cases (40.48%), 24 cases (28.57%) from patients and 26 cases (30.95%) from hospital management system. The number of days of hospitalization and the total cost of treatment in the observation group with improved clinical pathology was lower than that in the control group. The quality of medical care and patient satisfaction with the quality of nursing (97.12% vs 74.04%) were higher than those in the control group Statistical significance (P <0.05, P <0.01). Conclusion Based on the summary of the clinical pathological variables in patients with esophageal cancer, the targeted improvement of clinical nursing pathways in esophageal cancer, improved nursing intervention significantly improved, reducing hospitalization time and costs, improve the quality of care and patients Satisfaction and promotion of patient recovery.