小儿急性腹泻中医临床路径的验证总结

发布时间：2018-07-09 17:00

本文选题：急性腹泻 + 小儿腹泻病　；参考：《北京中医药大学》2012年硕士论文

【摘要】：小儿腹泻病(Infantile diarrhea)是一组由多病原、多因素导致的小儿消化系统疾病,临床表现为大便次数增多及大便性状改变,其中病程小于2周的为急性腹泻。在我国儿童中,腹泻病的发病率仅次于上呼吸道感染,是儿科重点防治的四病之一。中医将腹泻病称之为泄泻,将小儿泄泻辨证分为：风寒泻、湿热泻、伤食泻、脾虚泻、寒湿泻、脾肾阳虚泻等不同类型,予内服汤药、中成药,或外用推拿、中药贴敷等方法治疗。临床路径的概念来源于美国,是指针对某种疾病建立的一套标准化的诊疗程序。其核心在于将该疾病的诊断、检查、治疗、护理等活动标准化,形成具体的流程方案。上世纪80年代,美国政府为应对医疗费用的不断上涨,实行了按疾病诊断分类的定额预付款制(DRGs-PPS),迫使医院只有在医疗费用低于DRGs-PPS的标准费用时才能盈利。为此,医院开始使用临床路径来规范医疗流程,控制医疗成本,取得了良好的效果。之后,临床路径在英国、澳大利亚、新加坡、日本等国家也得到了广泛的应用。我国自1996年开始引进临床路径的概念,近些年随着医疗改革的推进,临床路径的研究逐渐得到医学界及政府部门的重视,并在全国多家医院进行了相关的临床试验,成效显著。在此基础上,中医临床路径的研究应运而生。中医临床路径是我国独有的,基于中医学理论、实践指导,应用中医学诊断模式、治疗方法与药物,以临床路径形式构建的特殊诊疗体系。它对促进中医学的标准化、规范化、科学化有重要意义。因为中医界在小儿泄泻的诊断及治疗方面意见并不统一,尤其是在诊断分类及中医外治法上,各流派、各地区差异较大,而泄泻又是小儿常见疾病,所以对其中医临床路径的研究是十分必要的。本文依据国家中医药管理局制订的小儿泄泻(小儿腹泻病)中医临床诊疗指南为参考,利用《小儿泄泻(小儿腹泻病)中医临床路径试点——急性门诊病例观察表(CRF表)》,在北京中医药大学东方医院儿科收集了30例小儿急性腹泻病例。对病例进行诊疗过程的记录、结果的回访与数据的整理统计,对临床路径的应用情况进行分析,进而总结出中医治疗小儿急性腹泻的临床特点与规律,验证其临床路径的实用性。其结果如下： (1)在5天的标准疗程日内,30例患儿中痊愈22例,显效4例,有效4例,痊愈率73.3%,显效率86.7%,有效率100%。 (2)小儿急性腹泻中医辨证分型按出现频率由多到少依次为：湿热泻、伤食泻、脾虚泻、风寒泻,寒湿泻与脾肾阳虚泻临床少见； (3)中医药治疗小儿腹泻常用治疗途径依次为：中成药,中医外治法,中药汤药； (4)治疗湿热泻最常应用的中成药为苍苓止泻口服液,其次为枫蓼肠胃康颗粒,脾虚泻主要应用醒脾养儿颗粒及小儿肠胃康颗粒； (5)门诊平均总费用约为135.0元,其中药物费用占一半以上,其次是治疗费用,检查费用不到十分之一,中医治疗总体费用约占63%,中医特色比较突出； (6)患儿家长总体满意度达到97.3%,满意度较高。结论：应用中医临床路径治疗小儿急性腹泻,临床效果好,中医特色突出,家长满意度较高。
[Abstract]:Infantile diarrhoea (Infantile diarrhea) is a group of children with digestive system diseases caused by multiple pathogens and multiple factors. The clinical manifestation is the number of stool and the change of stool characters, among which the course of the disease is less than 2 weeks. In our children, the incidence of diarrhoea is only in the upper respiratory tract infection, which is the four disease of the key prevention and treatment of Pediatrics. First, Chinese medicine is called diarrhea disease, which is divided into three types: wind cold diarrhea, damp heat and diarrhea, diarrhea, diarrhea, cold and dampness and diarrhea, spleen and kidney yang deficiency and diarrhea. It is treated with Chinese medicine, Chinese patent medicine, external use massage, Chinese herbal medicine and so on.
The concept of clinical pathway originates in the United States and is a standardized set of diagnostic procedures established by the pointer to a certain disease. Its core is to standardize the diagnosis, examination, treatment and nursing of the disease and form a specific process plan. In the 80s of the last century, the United States government implemented the diagnosis of the disease according to the disease diagnosis. DRGs-PPS, which forces hospitals to make profit only when medical costs are less than DRGs-PPS, has begun to use clinical pathways to regulate medical processes, control medical costs and achieve good results. After that, the clinical pathway is also widely used in countries such as Britain, Australia, Singapore, Japan and other countries. General application.
China has introduced the concept of clinical path since 1996. In recent years, with the advancement of medical reform, the research of clinical pathway has been paid more attention by the medical and government departments, and the clinical trials have been carried out in many hospitals throughout the country. On this basis, the research of clinical path of traditional Chinese medicine has emerged. The clinical path of Chinese medicine is the path of traditional Chinese Medicine Our country is unique, based on the theory of traditional Chinese medicine, practice guidance, the application of traditional Chinese medicine diagnostic model, treatment methods and drugs, and the special diagnosis and treatment system constructed in the form of clinical pathway. It is of great significance to promote the standardization, standardization and scientification of Chinese medicine.
It is not unified in the diagnosis and treatment of children's diarrhea in the traditional Chinese medicine, especially in the classification of diagnosis and the external treatment of traditional Chinese medicine. The different schools and regions have great differences, and diarrhea is a common disease of children. Therefore, it is necessary to study the clinical path of Chinese medicine. The guide of clinical diagnosis and treatment of Chinese medicine for diarrhea (infantile diarrhoea) was used as a reference. 30 cases of acute diarrhea in children were collected in the Pediatrics Department of the Eastern Hospital of Beijing University of Chinese Medicine. The records of the diagnosis and treatment of the cases, the return visits and data of the results were recorded. The application of clinical pathway is analyzed, and the clinical characteristics and laws of treating acute diarrhea in children are summarized, and the practicability of the clinical pathway is verified.
The results are as follows:
(1) during the 5 days of standard treatment days, 30 cases were cured, 22 cases were effective, 4 cases were markedly effective, 4 cases were effective, the cure rate was 73.3%, the effective rate was 86.7%, and the effective rate was 100%.
(2) according to the frequency from many to less, the syndrome differentiation of acute diarrhea in children is in turn: Damp heat diarrhea, diarrhea and diarrhoea, spleen deficiency diarrhea, wind cold diarrhea, cold dampness diarrhea and spleen kidney yang deficiency diarrhea.
(3) Chinese medicine treatment of infantile diarrhea commonly used in the following ways: Chinese patent medicine, Chinese medicine external treatment, Chinese medicine decoction;
(4) the traditional Chinese medicine for the treatment of diarrhea and diarrhea is Cang Ling Zhixie oral liquid, followed by Maple Polygonum Chang Wei Kang Granule.
(5) the average total cost of the outpatient was about 135 yuan, including more than half of the cost of medicine, the second was the cost of treatment, the cost of examination was less than 1/10, the total cost of traditional Chinese medicine was about 63%, and the characteristics of traditional Chinese medicine were more prominent.
(6) the overall satisfaction of parents reached 97.3% and satisfaction was high.
Conclusion: the application of TCM clinical pathway in the treatment of children with acute diarrhea has good clinical effect, Prominent TCM features and high parental satisfaction.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272

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