哮病（支气管哮喘）急性发作期中医临床路径的应用观察

发布时间：2018-03-17 20:07

  本文选题：中医临床路径　切入点：哮病　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的：支气管哮喘(简称哮喘)是一种以多种炎性细胞渗出为主,伴慢性气道炎症和气道高反应性改变的慢性呼吸系统疾病。2014年全球哮喘防治创议(GINA)强调哮喘是一种异质性疾病,通常以反复发作性气短喘息、不明原因的胸闷和慢性咳嗽为临床表现,并具有可变性呼气气流受限。随着世界经济一体化和工业化,全球哮喘患者已经增加至1.6亿,WHO报道,在全世界范围计算,哮喘相关的经济花费明显高于艾滋病和结核病的总花费。我国哮喘患者高达2000万,其中儿童哮喘患病率达0.12%-3.34%。哮喘的发病率和死亡率逐年上升,给患者带来沉重的生活压力,也给我国医疗体系带来巨大的医疗负担。因此,我们需要探索“高效”、“低成本”的治疗方式,从美国发展起来的临床路径为解决这一问题提供了良好的证据。哮喘属于中医学“哮病”范畴,中医对哮病的诊治具有较好的临床效果,制定标准化的哮病(支气管哮喘)中医临床路径是将中医诊治哮病的方法通过临床路径进行总结和规范,在改善诊疗质量的同时降低医疗成本,发扬中医特色。为探讨哮病中医临床路径的有效性与可行性,本课题对我院呼吸科支气管哮喘发作期住院患者实施我院哮病(支气管哮喘)中医临床路径治疗方案,运用统计学方法评价我院哮病(支气管哮喘)中医临床路径对中医症候疗效、ACT表评分、住院费用、住院天数、中医特色使用情况和患者满意度的影响,通过观察哮病(支气管哮喘)中医临床路径对哮病的疗效,初步评估我院哮病(支气管哮喘)中医临床路径的实施情况和临床效果,为哮病的中医临床路径的实施提供临床依据,也为进一步制定和验证呼吸专科其他病种的中医临床路径提供参考和可借鉴的经验。研究方法：将广州市中医医院呼吸专科60例符合哮病纳入标准的住院患者按照随机数字表法随机分为两组,即观察组和对照组。观察组按我院哮病(支气管哮喘)中医临床路径制定的路径方案治疗,对照组按对照组方案治疗。比较两组患者治疗前后中医症候积分(按尼莫地平法计算,分为无效、有效、显效、临床痊愈)、ACT表得分(分为未得到控制、部分控制、完全控制),并对比两组平均住院天数、平均住院总费用、中医特色使用情况和患者满意度。研究成果：符合纳入标准的共60例患者,其中对照组1例患者因失访而剔除,共59例患者参与本研究。本研究结果显示两组前后中医症候积分均具有可比性,两组有效率均达100%；两组ACT表得分统计比较显示观察组随访病人治疗前ACT表得分具有可比性,治疗后3个月随访ACT表得分观察组较对照组高；观察组治疗可以使患者出院时嗜酸性粒细胞百分比较入院时下降；观察组的平均住院天数显著低于对照组；观察组的平均住院费用较对照组显降低；观察组中医特色疗法使用较对照组多,含中药、中成药、无烟艾灸仪、穴位敷贴、穴位注射、中药热奄包。研究结论：我院实施中医临床路径治疗支气管哮喘急性发作期患者的疗效较确切,无变异,可缩减住院天数和住院费用,中医特色治疗使用增多,医患沟通增加,医护服务质量提高,得到患者的肯定,临床可推广。
[Abstract]:Objective: bronchial asthma (asthma) is a kind of main exudation of inflammatory cells, with chronic airway inflammation and airway hyperresponsiveness change of chronic respiratory disease.2014 Gina (GINA) stressed that asthma is a heterogeneous disease, usually with recurrent episodes of wheezing and shortness of breath, unexplained the clinical manifestations of chronic cough and chest tightness, and variable expiratory flow limitation. With the integration of the world economy and industrialization, the global asthma patients has increased to 160 million, WHO reported that the calculation in the whole world, the economic cost of the total cost of asthma was significantly higher than that of HIV and TB. Up to 20 million of our patients with asthma, and asthma in children the prevalence rate of 0.12%-3.34%. in asthma morbidity and mortality increased year by year, brought the heavy pressure of life to the patients, but also to our health care system with huge medicine The burden of treatment. Therefore, we need to explore the "efficiency", "low cost" treatment, the clinical pathway developed from the United States to provide good evidence to solve this problem. The asthma medicine belongs to "asthma" category, diagnosis and treatment of asthma disease of traditional Chinese medicine has good clinical effect, the standard asthma (asthma) of TCM clinical pathway is a method of TCM diagnosis and treatment of asthma disease were summarized and normalized by the clinical path, reduce the cost of medical care in improving the quality of diagnosis and treatment at the same time, the development of traditional Chinese characteristics. To explore the feasibility and effectiveness of the asthma disease of TCM clinical pathway, the Department of respiration of our hospital in bronchial asthma patients the implementation of our hospital asthma (asthma) clinical pathway for treatment of traditional Chinese medicine, the use of statistical methods to evaluate our hospital asthma (asthma) of TCM clinical pathway of TCM syndrome curative effect, ACT score, 浣忛櫌璐圭敤,浣忛櫌澶╂暟,涓�鍖荤壒鑹蹭娇鐢ㄦ儏鍐靛拰鎮ｈ�呮弧鎰忓害鐨勫奖鍝，

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