| 1BackgroundBronchiectasis is a chronic and common disease of respiratory system, long course of disease, disease is irreversible. The prevalence of bronchiectasis increased with increasing age.bronchiectasis in China the prevalence rate was0.3%-0.5%. Due to repeated infection, frequent use of antibiotics, drug-resistant strains increase, not only to increase the difficulty of treatment, to patients bring heavy psychological pressure and economic burden, serious influence patient’s quality of life, has become a public health problem.There are many links needs specification in bronchiectasis patients, such as the choice of antibiotic treatment, and related inspection the necessity, leading to bronchiectasis etiology screening, decrease the cost of hospitalization, hospitalization time, standardized TCM syndrome type, Aiming at these problems, the implementation of clinical pathway, especially of TCM clinical pathway may be a useful exploration. Clinical pathway is to reduce medical variation, improve curative effect, at the same time, cost control, Research on the clinical path of traditional Chinese medicine is still in its early stage, lack of related research, and the research about the bronchiectasis of TCM clinical pathway is scanty, so it is necessary to establish the clinical path of bronchiectasis, effective, reasonable medicine standard.2ObjectiveAnalysis of clinical pathway in patients with bronchiectasis before and after the implementation of the relevant medical data, to explore the clinical pathway implementation of related medical care, inpatient management provide the basis for bronchiectasis.3MethodsDepartment of respiration Xiyuan Hospital implementation of bronchiectasis clinical path management began in2012August, to20143at the end of the first diagnosis of bronchial tube expansion of patients with a total of60cases, including52cases entered the path management. In2012August to2014March in patients with bronchiectasis path management for52cases of path. Methods a retrospective study from2009January to2012July in patients with bronchiectasis (prior to the implementation of the clinical pathway) of48patients in the control group,(51patients,3cases were excluded because of incomplete data); Through access to relevant literature, making medical record information collection table, query Chinese digital Academy of traditional Chinese medicine, Xiyuan Hospital of electronic medical record system, The two groups of patients with related data collection, collation, the relevant information into the Excel table, statistic analysis and introducing the SPSS17。system.4Result(1) The TCM syndromes:compared two groups of patients in treatment for7days,14days and before treatment, the TCM syndromes were decreased (P<0.05), but the comparison between groups had no significant difference (P>0.05); but the two groups in the treatment of cough, expectoration14days single symptom integral comparison, the path group than the control group(P<0.05).(2) Effect of syndrome of traditional Chinese medicine:two groups after treatment for14days there were no significant difference (P>0.05), but the path group control rate is better than the control group (P<0.05).(3) Laboratory indexes (blood white cells and neutrophils):path group and control group after treatment were significantly improved, but the comparison between two groups, no significant difference (P>0.05).(4) The two groups are in the phlegm heat dampness type patients, different in traditional Chinese medicine decoction used in, Routing groups use Phragmitis decoction treatment; control group of9cases with a reed stem Decoction (52.9%), Maxing Shigan Decoction and3cases (17.6%),3cases of the Qingjin expectorant Decoction (17.6%), the other2patients (11.8%).(5) Two groups of patients are based on the three generation cephalosporin antibiotics, but the control group using a combination of antibiotics were more than two higher than the path group (P<0.05).(6) The actual length of hospital stay:path set of actual length of hospital stay was14.79±5.47(days), the control group the actual length of hospital stay was17.92±6.72(days), Path set of actual length of hospital stay were significantly less than that of the control group, with statistical significance (P<0.05).(7)14days of hospitalization expenses:according to statistics,10685.5+3967.7paths for the group average hospitalization cost (yuan), the control group11450.2±4971.9(yuan) average cost, the total cost of the path group than in the control group.(8) Two groups of patients hospitalized time≤14days and>14days subgroup analysis of the patients with:≤TCM syndrome type14days in patients with phlegm dampness type, a total of24cases (55.8%),>14day with lung and spleen deficiency combined with two heat phlegm, a total of26cases (45.6%);≤14days in patients with a total of10patients with sputum culture positive strains, which were mainly Pseudomonas aeruginosa (8strains),＞14days a total of22cases of patients with sputum culture positive strains, also in Pseudomonas aeruginosa (9strains), but5cases except Pseudomonas aeruginosa is associated with other bacteria.5ConclusionThrough the implementation of a retrospective study comparing TCM clinical pathway in patients with bronchiectasis, conclusions are as follows:(1) In the premise of ensuring efficacy, the implementation of clinical pathway can reduce the length of hospital stay, reduce the cost of hospitalization in patients with bronchiectasis.(2) The implementation of clinical path consistency for traditional Chinese medicine treatment, standardize the use of antibiotics, thus reducing the cost of the corresponding.(3)TCM syndrome type of wind heat invading lung, phlegm heat dampness, liver fire attacking lung patients14days to achieve clinical control and discharge standards, The path may be more suitable for the path management syndrome; While the retention of phlegm heat in the lung and pulmonary spleen deficiency patients hospitalized longer two, Tips for such patients with this syndrome, path plan14days can be further improved.(4) Sputum culture for herpes infection of Pseudomonas aeruginosa in the treatment of patients with more than14days to control the disease, But at the same time, there are more than2kinds of strains were often prolong hospitalization. |
PDF Full Text Request