本文選題：中醫(yī)臨床路徑　切入點(diǎn)：哮病　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的：支氣管哮喘(簡稱哮喘)是一種以多種炎性細(xì)胞滲出為主,伴慢性氣道炎癥和氣道高反應(yīng)性改變的慢性呼吸系統(tǒng)疾病。2014年全球哮喘防治創(chuàng)議(GINA)強(qiáng)調(diào)哮喘是一種異質(zhì)性疾病,通常以反復(fù)發(fā)作性氣短喘息、不明原因的胸悶和慢性咳嗽為臨床表現(xiàn),并具有可變性呼氣氣流受限。隨著世界經(jīng)濟(jì)一體化和工業(yè)化,全球哮喘患者已經(jīng)增加至1.6億,WHO報(bào)道,在全世界范圍計(jì)算,哮喘相關(guān)的經(jīng)濟(jì)花費(fèi)明顯高于艾滋病和結(jié)核病的總花費(fèi)。我國哮喘患者高達(dá)2000萬,其中兒童哮喘患病率達(dá)0.12%-3.34%。哮喘的發(fā)病率和死亡率逐年上升,給患者帶來沉重的生活壓力,也給我國醫(yī)療體系帶來巨大的醫(yī)療負(fù)擔(dān)。因此,我們需要探索“高效”、“低成本”的治療方式,從美國發(fā)展起來的臨床路徑為解決這一問題提供了良好的證據(jù)。哮喘屬于中醫(yī)學(xué)“哮病”范疇,中醫(yī)對哮病的診治具有較好的臨床效果,制定標(biāo)準(zhǔn)化的哮病(支氣管哮喘)中醫(yī)臨床路徑是將中醫(yī)診治哮病的方法通過臨床路徑進(jìn)行總結(jié)和規(guī)范,在改善診療質(zhì)量的同時(shí)降低醫(yī)療成本,發(fā)揚(yáng)中醫(yī)特色。為探討哮病中醫(yī)臨床路徑的有效性與可行性,本課題對我院呼吸科支氣管哮喘發(fā)作期住院患者實(shí)施我院哮病(支氣管哮喘)中醫(yī)臨床路徑治療方案,運(yùn)用統(tǒng)計(jì)學(xué)方法評價(jià)我院哮病(支氣管哮喘)中醫(yī)臨床路徑對中醫(yī)癥候療效、ACT表評分、住院費(fèi)用、住院天數(shù)、中醫(yī)特色使用情況和患者滿意度的影響,通過觀察哮病(支氣管哮喘)中醫(yī)臨床路徑對哮病的療效,初步評估我院哮病(支氣管哮喘)中醫(yī)臨床路徑的實(shí)施情況和臨床效果,為哮病的中醫(yī)臨床路徑的實(shí)施提供臨床依據(jù),也為進(jìn)一步制定和驗(yàn)證呼吸�？破渌》N的中醫(yī)臨床路徑提供參考和可借鑒的經(jīng)驗(yàn)。研究方法：將廣州市中醫(yī)醫(yī)院呼吸�？�60例符合哮病納入標(biāo)準(zhǔn)的住院患者按照隨機(jī)數(shù)字表法隨機(jī)分為兩組,即觀察組和對照組。觀察組按我院哮病(支氣管哮喘)中醫(yī)臨床路徑制定的路徑方案治療,對照組按對照組方案治療。比較兩組患者治療前后中醫(yī)癥候積分(按尼莫地平法計(jì)算,分為無效、有效、顯效、臨床痊愈)、ACT表得分(分為未得到控制、部分控制、完全控制),并對比兩組平均住院天數(shù)、平均住院總費(fèi)用、中醫(yī)特色使用情況和患者滿意度。研究成果：符合納入標(biāo)準(zhǔn)的共60例患者,其中對照組1例患者因失訪而剔除,共59例患者參與本研究。本研究結(jié)果顯示兩組前后中醫(yī)癥候積分均具有可比性,兩組有效率均達(dá)100%；兩組ACT表得分統(tǒng)計(jì)比較顯示觀察組隨訪病人治療前ACT表得分具有可比性,治療后3個(gè)月隨訪ACT表得分觀察組較對照組高；觀察組治療可以使患者出院時(shí)嗜酸性粒細(xì)胞百分比較入院時(shí)下降；觀察組的平均住院天數(shù)顯著低于對照組；觀察組的平均住院費(fèi)用較對照組顯降低；觀察組中醫(yī)特色療法使用較對照組多,含中藥、中成藥、無煙艾灸儀、穴位敷貼、穴位注射、中藥熱奄包。研究結(jié)論：我院實(shí)施中醫(yī)臨床路徑治療支氣管哮喘急性發(fā)作期患者的療效較確切,無變異,可縮減住院天數(shù)和住院費(fèi)用,中醫(yī)特色治療使用增多,醫(yī)患溝通增加,醫(yī)護(hù)服務(wù)質(zhì)量提高,得到患者的肯定,臨床可推廣。
[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尰鐗硅壊浣跨敤鎯呭喌鍜屾?zhèn)ｈ�呮弧鎰忓害鐨勫獎(jiǎng)鍝，

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