眩晕（后循环缺血）痰瘀阻窍证中医临床路径实施效果分析

发布时间：2018-04-07 18:47

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

【摘要】：目的：分析评价眩晕(后循环缺血)痰瘀阻窍证中医临床路径的实施效果,对患者住院天数、住院费用以及患者满意度的影响,提供高级别证据以支持该路径临床推广。方法：按照纳入排除标准收集60例患者,随机分为路径组和对照组。路径组严格按照国家中医药管理局颁布的眩晕(后循环缺血)中医临床路径住院流程及诊疗方案进行,对照组住院流程及诊疗方案由主管医生按临床经验执行。记录眩晕中医症候量表评分,眩晕程度分级及主要伴发症状,记录患者住院天数及住院费用,收集两组患者中医特色疗法使用情况,进行患者满意度调查。出院后1月电话随访,统计两组患者眩晕复发率及因眩晕再次住院率。综合以上数据进行统计分析。结果：研究共纳入60例患者,脱落2例,最终统计58例。经治疗,路径组总有效率100%,高于对照组93.1%,但两组比较无统计学意义(P0.05)。治疗后两组中医症候量表评分及眩晕主症均有显著改善,但两组间比较无统计学意义(P0.05),在眩晕主要伴发症状的改善方面,路径组效果优于对照组(P0.05)。路径组平均住院费用8471.309±1829.118元,平均住院天数9.59±2.413天,均低于对照组(10876.981±2581.560元,13.97±3.60天),且两组比较差异显著(P0.05)。在满意度调查方面：对治疗效果评价,路径组满意度100%,对照组86.2%,P0.05；对住院费用评价,路径组满意度96.6%,对照组82.8%,P0.05；对疗程评价,路径组满意度100%,对照组86.2%,P0.05；对诊疗服务评价,路径组满意度100%,对照组86.2%,P0.051对路径方案的接受度,路径组接受度100%,对照组86.2%,P0.05。中医特色疗法使用比较,路径组使用2种以上特色疗法29例,对照组使用2种以上中医特色疗法16例,P0.05。出院后1月随访两组组眩晕复发率(路径组10.3%,对照组27.6%,P0.05),再住院率(路径组6.9%,对照组20.7%,P0.05)。结论：眩晕(后循环缺血)痰瘀阻窍证中医临床路径疗效显著。该路径方案可缩短患者住院天数,降低住院费,节省医疗资源,提高医疗质量。该路径住院流程规划合理,可全面提高患者对疗程、疗效、诊疗服务、住院费用的满意度。该路径对本病长期预后有一定改善作用,且中医特色突出,患者接受度高,适宜临床推广。
[Abstract]:Objective: to analyze and evaluate the effect of traditional Chinese medicine (TCM) clinical pathway of phlegm stasis obstruction syndrome of vertigo (posterior circulation ischemia), and to provide high level evidence to support the clinical popularization of the pathway.Methods: 60 patients were randomly divided into path group and control group according to exclusion criteria.The path group was carried out strictly according to the hospital procedure and diagnosis and treatment plan of vertigo (posterior circulation ischemia) issued by the State Administration of traditional Chinese Medicine, while the hospital procedure and diagnosis and treatment plan of the control group were carried out by the doctor in charge according to the clinical experience.The score of TCM symptom scale of vertigo, the classification of vertigo degree and main accompanying symptoms, the days of hospitalization and the cost of hospitalization were recorded, and the use of traditional Chinese medicine characteristic therapy in the two groups were collected, and the patients' satisfaction was investigated.1 month after discharge, the recurrence rate of vertigo and the rate of rehospitalization due to vertigo were calculated.Comprehensive above data for statistical analysis.Results: a total of 60 patients were included in the study, 2 cases dropped out and 58 cases were finally counted.After treatment, the total effective rate of the path-group was 100%, which was higher than that of the control group (93.1%), but there was no significant difference between the two groups (P 0.05).After treatment, the scores of TCM symptom scale and the main symptoms of vertigo in the two groups were significantly improved, but there was no significant difference between the two groups. In the improvement of the main accompanied symptoms of vertigo, the effect of the path group was better than that of the control group (P 0.05).The average hospitalization cost and average hospitalization days of the path-group were 8471.309 卤1829.118 yuan and 9.59 卤2.413 days, respectively, which were lower than that of the control group (10876.981 卤2581.560 yuan, 13.97 卤3.60 days), and the difference between the two groups was significant (P 0.05).In the aspect of satisfaction investigation, the satisfaction of the path-group was 100, that of the control group was 86.2P0.05; for the evaluation of hospitalization expenses, the satisfaction of the path-group was 96.6b, and that of the control group was 82.8p0.05; for the course of treatment, the satisfaction of the path-group was 100, and that of the control group was 86.2and P0.05.The satisfaction degree of the path group was 100, the acceptance of the path scheme was 100 in the control group 86.2 and P 0.051 in the control group, and the acceptance degree in the path group was 100, the control group was 86.2 and P 0.05.Compared with the traditional Chinese medicine characteristic therapy, the path group used more than 2 kinds of characteristic therapy in 29 cases, and the control group used more than 2 kinds of traditional Chinese medicine characteristic therapy in 16 cases (P0.05).One month after discharge, the recurrence rate of vertigo in the two groups (10.3% in path group, 27.6% in control group, P0.05% in control group) and rehospitalization rate (6.9% in path group and 20.775% in control group) were followed up.Conclusion: the curative effect of TCM clinical pathway of vertigo (posterior circulation ischemia) phlegm stasis obstructing orifices syndrome is remarkable.The route scheme can shorten the days of hospitalization, reduce the cost of hospitalization, save medical resources and improve the quality of medical treatment.This route can improve the patients' satisfaction with the course of treatment, curative effect, diagnosis and treatment service, and hospital expenses.This pathway can improve the long-term prognosis of the disease, and the characteristics of traditional Chinese medicine are prominent, the patient acceptance is high, suitable for clinical promotion.
【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】：2016
【分类号】：R277.7

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