急性心肌梗死住院患者应用临床路径的效果评价(PDF)
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2012年第1期
- 页码:
- 46-49
- 栏目:
- 临床研究
- 出版日期:
- 2012-02-25
文章信息/Info
- Title:
- Assessment of the clinical pathway effect for acute myocardial infarction
- Author(s):
- TUO Wen; SUN Min; XU Kai; XING Er-ke; GUO Hong; ZHANG Hui-jun; LIANG Ze-min
- (Baoji Cardiology Center of Diagnosis and Treatment, Baoji Hospital of Traditional Chinese Medicine, Baoji 721001, Shaanxi, China)
- Keywords:
- AMI; clinical pathway; early reperfusion therapy; hospitalization days; survival
- 分类号:
- R541.4
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的:评价在急性心肌梗死(AMI)住院患者诊治中应用临床路径的效果。方法： 根据ACC/AHA及中国急性冠脉综合征诊治指南制定我院AMI临床路径，并将临床路径附在病例中，每6 个月对关键环节执行情况进行一次评估，并对数据进行分析，提出改进措施。以我院心内科住院AMI患者为研究对象，临床路径应用前收集2006年10月~2008年3月住院AMI患者76（男54，女22）例，年龄（63±12）岁，作为应用前对照组（应用前组）；应用临床路径后连续收集2008年4月~2009年9月住院AMI患者98（男74，女24）例，年龄（62±12）岁，作为临床路径应用组（应用组）。结果： 临床路径应用组AMI患者住院时间较应用前明显缩短，其中急性ST抬高心肌梗死患者住院天数［（13±8）d vs.(9±7)d,P<0.05］，急性非ST抬高心肌梗死患者住院时间［(13±7)d vs.(7±9)d,P<0.05］;应用后高危患者接受冠脉造影率为78%，较应用前（48%）显著提高（P<0.01）;应用后急性ST抬高心肌梗死患者入院到球囊扩张时间（D-B时间）较应用前显著下降（P<0.01）;12 h内到达医院的ST抬高心肌梗死患者中早期再灌注治疗率临床路径应用前后分别为67%和87%（P<0.05）;AMI药物规范治疗方面，应用后联合用药明显提高;干预后AMI患者住院期间病死率较应用前显著下降（12% vs. 2%,P<0.05）。结论： 在 AMI住院患者中应用临床路径进行诊疗可显著改善医疗质量，提高临床疗效，缩短住院时间。
- Abstract:
- AIM:To optimize the diagnosis and treatment process, narrow the gap between clinical medicine and evidence-based medicine, improve the quality of diagnosis and treatment, reduce medical expenses, use limited medical service resources reasonably and offer patients the highest benefit. METHODS: According to ACC/AHA and Chinese acute coronary syndrome diagnosis and treatment guidelines, we developed our AMI clinical pathway and implemented its use in our hospital. Every 6 months an evaluation of the clinical pathway implemented was conducted in 76 AMI patients (admitted from October 2006 to March 2008) as a baseline before the implementation and 98 AMI patients (admitted from April 2008 to September 2009) after the implementation. RESULTS: After implementation of the clinical pathway, hospitalization time was significantly shortened, with a 3.5-day reduction in ST segment elevation myocardial infarction (STEMI) patients and 6.14-day reduction in non-STEMI patients (P<0.05). The rate of high-risk patients undergoing coronary angiography increased from 48% to 78% (P<0.01), whereas the “door-to balloon” (DB) time of STEMI patients decreased by 43% (P<0.01). The rate of early reperfusion in STEMI patients arriving at the hospital within 12 h was enhanced from 67% to 87%, combined use of ACEI/ARB markedly increased (P<0.05) and mortality rate in AMI patients decreased by 9.8% (P<0.05). CONCLUSION: Implementation of the clinical pathway for AMI patients greatly reduces hospitalization days, decreases DB time, increases proportion of emergency PCI for STEAMI patients and significantly reduces mortality rate.
参考文献/References
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备注/Memo
- 备注/Memo:
- 收稿日期：2011-03-21.作者简介：拓文，副主任医师 Email:dontw@163.com
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