本文選題：突發(fā)性耳聾　切入點：臨床路徑　出處：《廣州中醫(yī)藥大學(xué)》2011年碩士論文

【摘要】：背景 突發(fā)性耳聾又稱特發(fā)性突聾,屬世界公認(rèn)的耳鼻喉科常見多發(fā)病,由于病因未明,迄今為止國內(nèi)外現(xiàn)代醫(yī)學(xué)尚無廣泛公認(rèn)療效確切的治療手段,多為經(jīng)驗治療。而傳統(tǒng)中醫(yī)藥針灸具有療效確切、廉價、副作用小、病人樂于接受等優(yōu)點,通過臨床觀察和前期研究,發(fā)現(xiàn)中醫(yī)藥及針灸療法對治療本病具有較好的療效。目前國內(nèi)外已開始了運用中醫(yī)藥及針灸治療本病的研究,并取得了良好的成效。提高突發(fā)性耳聾的預(yù)防治療水平,降低其醫(yī)療費用,已成為耳鼻喉科領(lǐng)域和衛(wèi)生管理領(lǐng)域一個重要的研究方向。 臨床路徑不僅能顯著提高臨床療效,同時也能提高醫(yī)療質(zhì)量和醫(yī)療安全,更可以有效降低住院時間和住院費用,受到各國醫(yī)學(xué)界的重視,成為20世紀(jì)以來的一種嶄新的醫(yī)療模式。 目的 本研究在綜合中西醫(yī)最先進的研究成果基礎(chǔ)上,盡最大程度發(fā)揮中醫(yī)藥治療突發(fā)性耳聾的特色優(yōu)勢,通過建立、實施及評價突發(fā)性耳聾治療的臨床路徑,積極尋求治療本病的突破點,以期不斷提高醫(yī)療質(zhì)量和安全,控制醫(yī)療費用,構(gòu)建和諧醫(yī)患關(guān)系。 方法 根據(jù)納入及排除標(biāo)準(zhǔn),選擇自2008年8月至2010年7月在廣東省中醫(yī)院耳鼻喉科住院的第一診斷為突發(fā)性耳聾的病人為研究對象,2008年8月——2009年7月期間按舊路徑治療的病例105例中隨機選取60例為對照組,2009年8月——2010年7月按新臨床路徑治療的病例80例中隨機選取60例為治療組,共120例。將患者根據(jù)性別,年齡、發(fā)病時間,住院天數(shù)、住院費用、療效等級、安全性、有無伴眩暈、耳鳴、中醫(yī)證型等進行頻數(shù)分布分析；對主要數(shù)據(jù)如比較兩組有效率的差異性采用非參數(shù)檢驗,對住院天數(shù)和住院費用進行對比差異性分析用T檢驗。并觀察患者的住院費用、路徑執(zhí)行變異情況、路徑安全性、患者的滿意度的情況,為突發(fā)性耳聾臨床路徑的完善及提高提供依據(jù)。 結(jié)果 本研究共納入120例,對照組中男性30例(50%),女性30例(50%)。其中年齡19～65歲,平均年齡42.92±13.76歲,發(fā)病到就診時間為1～27天,平均9.20±6.59天,伴眩暈者10例,伴耳鳴者59例。平均住院天數(shù)：13.87±5.15天。治療組中男性22例(37%),女性38例(63%)。其中年齡19-71歲,平均年齡44.32±14.65歲,伴眩暈者27例,伴耳鳴者57例。平均住院天數(shù)：12±5.12天。 結(jié)果分析,新舊路徑在住院平均總費用及總有效率方面沒有明顯差異(P0.05),在平均住院天數(shù)方面有顯著性差異(P0.05)。 結(jié)論 1.治療組路徑治療方案是安全有效的。 2.對照組路徑中病人對治療效果及總體服務(wù)的滿意度比較高,分別達到了78%及95%。 3.病人因素是臨床路徑執(zhí)行過程中出現(xiàn)變異的主要因素。 4.對照組路徑可以明顯縮短住院天數(shù)(新舊路徑平均住院天數(shù)對比有明顯差異)。 5.治療及對照組路徑平均住院總費用及總有效率方面沒有明顯差異,治療組路徑并不比對照組路徑有明顯的優(yōu)勢。
[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 鹵 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 .

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R764.43

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