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目的探讨临床路径管理在小儿毛细支气管炎中的应用效果及其对抗菌药物使用率的影响。方法选取南皮县人民医院2014年10月—2016年4月收治的毛细支气管炎患儿75例为研究组,2013年10月—2014年9月收治的毛细支气管炎患儿68例为对照组。研究组予以临床路径管理,对照组予以常规管理。研究组实施临床路径管理时将抗菌药物的应用作为变异因素,将降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)升高及细菌学检查阳性作为用药指征,并制定抗菌药物选用原则,加强抗菌药物的应用管理。比较两组患儿治愈率、抗菌药物使用率、院内感染率、住院费用、药品费用、住院时间、2周内再住院率及服务满意度。结果两组患儿治愈率比较,差异无统计学意义(P>0.05);研究组患儿抗菌药物使用率低于对照组(P<0.05)。两组患儿中仅研究组一例患儿发生院内感染。两组患儿住院费用比较,差异无统计学意义(P>0.05),研究组患儿药品费用低于对照组,住院时间短于对照组,服务满意度高于对照组(P<0.05)。两组患儿均无一例2周内再住院。结论通过对小儿毛细支气管炎实行路径管理,可规范抗菌药物的合理应用,降低抗菌药物使用率。
Objective To explore the clinical application of path management in children with bronchiolitis and its effect on the use of antibiotics. Methods 75 patients with bronchiolitis admitted to Nanpi County People’s Hospital from October 2014 to April 2016 were selected as the research group. 68 children with bronchiolitis admitted from October 2013 to September 2014 were selected as the control group . The study group to be clinical path management, the control group to be routine management. The study group used antibacterials as a variation factor in the implementation of clinical pathway management, and used as the indication of the medication the increase of procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and bacteriological examination The development of antimicrobial drug selection principles, strengthen the application of antimicrobial agents. The cure rate, antimicrobial use rate, nosocomial infection rate, hospitalization cost, drug cost, hospital stay, rehospitalization rate within 2 weeks and service satisfaction were compared between the two groups. Results There was no significant difference in cure rate between the two groups (P> 0.05). The use rate of antibacterials in study group was lower than that in control group (P <0.05). Only two children in the study group developed a nosocomial infection in children. There was no significant difference in hospitalization costs between the two groups (P> 0.05). The cost of medication in study group was lower than that in control group, the length of stay in hospital was shorter than that in control group, and the service satisfaction was higher than that in control group (P <0.05). No two children were hospitalized in two weeks. Conclusion The management of pediatric bronchiolitis can regulate the rational use of antimicrobial agents and reduce the usage of antimicrobial agents.