急性心肌梗死中西医结合临床路径的构建及初步评价研究

作者	单位
张敏州	广东省中医院心脏中心
张军	广东省中医院心脏中心
张俭	广东省中医院心脏中心
杨广	广东省中医院心脏中心
王磊	广东省中医院心脏中心
唐光华	广东省中医院心脏中心
郭力恒	广东省中医院心脏中心
陈全福	广东省中医院心脏中心

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中文摘要:

目的探讨急性心肌梗死(acute myocardial infarction,AMI)中西医结合临床路径(clinical path-way,CP)的构建和疗效评价。方法采用非同期队列研究,在治疗指南和益气活血法的基础上,建立AMI中西医结合临床路径,根据临床路径实施前后分为CP组(71例)和非CP组(70例),观察两组的总住院时间、ICU住院时间和总住院费用,对于行直接PCI的亚组患者,比较其就诊-球囊扩张(door-to-balloon,DTB)时间。结果 CP组总住院时间(天)低于非CP组(9.80±5.62vs12.01±7.35,P<0.05),两组住院费用差异无统计学意义。对于行PCI的亚组患者,CP组DTB时间(min,82.56±17.36vs119.19±30.88,P<0.01)、总住院时间(9.69±5.59vs13.34±7.49,P<0.01)和住院费用均低于非CP组。结论以益气活血法为基础的急性心肌梗死中西医结合临床路径,可以降低AMI住院时间,控制直接PCI患者的住院费用和DTB时间,充分体现出中西医结合临床路径在AMI医院管理和质量控制方面的价值。

英文摘要:

Objective To establish an integrative medical approach (IMA) for clinical management of acute myocardial infarction (AMI),and to test its efficacy. Methods IMA was preliminarily established according to the guidelines and based on the Chinese medical therapy of benefiting vital qi and promoting blood circulation. And adopting non-synchronous queue design,AMI patients were assigned to the IMA group (71 cases) and the non-IMA group(70 cases),they were managed following or didn’t follow the established IMA respectively. The total hospitalization time (THT),the ICU indwelling time (ICUD) and the total medical expenditure (TME) of patients were compared between groups. Moreover,for patients received primary PCI,the time for door-to-balloon (DTB) was compared in addition. Results Comparisons between groups showed that THT in the IMA group was shorter than that in the non-IMA group (9.80±5.62 days vs. 12.01±7.35 days,P<0.05); but the difference of TME between groups was insignificant. For those received PCT,the DTB in the IMA group was shorter than that in the non-IMA group in terms of DTB time (82.56±17.36 min vs. 119.19±30.88 min,P<0.01),THT (9.69±5.59 vs. 13.34±7.49 days,P<0.01) and TME. Conclusions Practicing IMA for AMI,which was established based on Chinese medical therapy of benefiting vital qi and promoting blood circulation,could shorten the hospitalization time of patients,reduce the DTB time and TME in patients receiving primary PCI; fully displays its significance in hospital administration and quality control on AMI.

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