拓文, 孙敏, 徐楷, 邢尔克, 郭宏, 张会军, 梁泽民. 急性心肌梗死住院患者应用临床路径的效果评价[J]. 心脏杂志, 2012, 24(1): 46-49. DOI: 10.13191/j.chj.2012.01.52.tuow.013
    引用本文: 拓文, 孙敏, 徐楷, 邢尔克, 郭宏, 张会军, 梁泽民. 急性心肌梗死住院患者应用临床路径的效果评价[J]. 心脏杂志, 2012, 24(1): 46-49. DOI: 10.13191/j.chj.2012.01.52.tuow.013
    TUO Wen, SUN Min, XU Kai, XING Er-ke, GUO Hong, ZHANG Hui-jun, LIANG Ze-min. Assessment of the clinical pathway effect for acute myocardial infarction[J]. Chinese Heart Journal, 2012, 24(1): 46-49. DOI: 10.13191/j.chj.2012.01.52.tuow.013
    Citation: TUO Wen, SUN Min, XU Kai, XING Er-ke, GUO Hong, ZHANG Hui-jun, LIANG Ze-min. Assessment of the clinical pathway effect for acute myocardial infarction[J]. Chinese Heart Journal, 2012, 24(1): 46-49. DOI: 10.13191/j.chj.2012.01.52.tuow.013

    急性心肌梗死住院患者应用临床路径的效果评价

    Assessment of the clinical pathway effect for acute myocardial infarction

    • 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.

       

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