突发性耳聋临床路径实施的观察

发布时间：2018-03-30 11:11

本文选题：突发性耳聋　切入点：临床路径　出处：《广州中医药大学》2011年硕士论文

【摘要】：背景突发性耳聋又称特发性突聋,属世界公认的耳鼻喉科常见多发病,由于病因未明,迄今为止国内外现代医学尚无广泛公认疗效确切的治疗手段,多为经验治疗。而传统中医药针灸具有疗效确切、廉价、副作用小、病人乐于接受等优点,通过临床观察和前期研究,发现中医药及针灸疗法对治疗本病具有较好的疗效。目前国内外已开始了运用中医药及针灸治疗本病的研究,并取得了良好的成效。提高突发性耳聋的预防治疗水平,降低其医疗费用,已成为耳鼻喉科领域和卫生管理领域一个重要的研究方向。临床路径不仅能显著提高临床疗效,同时也能提高医疗质量和医疗安全,更可以有效降低住院时间和住院费用,受到各国医学界的重视,成为20世纪以来的一种崭新的医疗模式。目的本研究在综合中西医最先进的研究成果基础上,尽最大程度发挥中医药治疗突发性耳聋的特色优势,通过建立、实施及评价突发性耳聋治疗的临床路径,积极寻求治疗本病的突破点,以期不断提高医疗质量和安全,控制医疗费用,构建和谐医患关系。方法根据纳入及排除标准,选择自2008年8月至2010年7月在广东省中医院耳鼻喉科住院的第一诊断为突发性耳聋的病人为研究对象,2008年8月——2009年7月期间按旧路径治疗的病例105例中随机选取60例为对照组,2009年8月——2010年7月按新临床路径治疗的病例80例中随机选取60例为治疗组,共120例。将患者根据性别,年龄、发病时间,住院天数、住院费用、疗效等级、安全性、有无伴眩晕、耳鸣、中医证型等进行频数分布分析；对主要数据如比较两组有效率的差异性采用非参数检验,对住院天数和住院费用进行对比差异性分析用T检验。并观察患者的住院费用、路径执行变异情况、路径安全性、患者的满意度的情况,为突发性耳聋临床路径的完善及提高提供依据。结果本研究共纳入120例,对照组中男性30例(50%),女性30例(50%)。其中年龄19～65岁,平均年龄42.92±13.76岁,发病到就诊时间为1～27天,平均9.20±6.59天,伴眩晕者10例,伴耳鸣者59例。平均住院天数：13.87±5.15天。治疗组中男性22例(37%),女性38例(63%)。其中年龄19-71岁,平均年龄44.32±14.65岁,伴眩晕者27例,伴耳鸣者57例。平均住院天数：12±5.12天。结果分析,新旧路径在住院平均总费用及总有效率方面没有明显差异(P0.05),在平均住院天数方面有显著性差异(P0.05)。结论 1.治疗组路径治疗方案是安全有效的。 2.对照组路径中病人对治疗效果及总体服务的满意度比较高,分别达到了78%及95%。 3.病人因素是临床路径执行过程中出现变异的主要因素。 4.对照组路径可以明显缩短住院天数(新旧路径平均住院天数对比有明显差异)。 5.治疗及对照组路径平均住院总费用及总有效率方面没有明显差异,治疗组路径并不比对照组路径有明显的优势。
[Abstract]:Background

Sudden deafness is also known as idiopathic deafness , which belongs to the most common diseases in the world . Because of the unknown etiology , the traditional Chinese medicine acupuncture has the advantages of exact curative effect , low cost , small side effect and easy acceptance by patients . The traditional Chinese medicine acupuncture has the advantages of definite curative effect , low cost , small side effect and easy acceptance by patients .

The clinical pathway not only can obviously improve the clinical curative effect , but also can improve the medical quality and the medical safety , and can effectively reduce the hospitalization time and the hospitalization expense , and is valued by the medical community of various countries , and is a brand - new medical model since the 20th century .

Purpose

Based on the most advanced research results of integrated traditional Chinese medicine and western medicine , this study has the best use of Chinese medicine in the treatment of sudden deafness , through the establishment , implementation and evaluation of the clinical pathway of sudden deafness treatment , actively seek the breakthrough point of treatment of this disease , in order to improve medical quality and safety , control medical expense , and build harmonious doctor - patient relationship .

method

According to the inclusion and exclusion criteria , the first diagnosis for hospitalized patients with sudden deafness was selected from August 2008 to July 2010 . 60 cases were randomly selected from the cases treated with the old path from August 2008 to July 2009 . Among them , 60 cases were randomly selected as control group , and 120 cases were randomly selected according to sex , age , onset time , hospitalization days , hospitalization expenses , efficacy grade , safety , presence or absence of vertigo , tinnitus , syndrome type of TCM , etc .
For the main data , such as comparing the difference of the effective rates between the two groups , the non - parametric test was adopted to analyze the difference of the hospitalization days and the hospitalization expenses , and the patient ' s hospitalization expenses , the path performance variation , the path safety and the patient ' s satisfaction were observed , and the basis for the improvement and improvement of the clinical pathway of sudden deafness was provided .

Results

There were 120 males and 30 females ( 50 % ) in the control group . Among them , the age ranged from 19 to 65 years , the mean age was 42.92 卤 13.76 years .

Results The average total cost and the total effective rate of the new and old paths were not significantly different ( P0.05 ) . There was a significant difference in the mean hospitalization days ( P0.05 ) .

Conclusion

1 . The treatment group path treatment protocol is safe and effective .

2 . The satisfaction of the patients in the control group was 78 % and 95 % , respectively .

3 . Patient factors are the main factors in the course of clinical pathway execution .

4 . The route of the control group could significantly shorten the hospitalization days ( the average length of hospital stay in the new and old path is obviously different ) .

5 . There was no significant difference between treatment group and control group ' s average total hospitalization cost and total effective rate , and the path of treatment group was no more obvious than that of control group .

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764.43

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