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

【摘要】：目的：分析評價(jià)眩暈(后循環(huán)缺血)痰瘀阻竅證中醫(yī)臨床路徑的實(shí)施效果,對患者住院天數(shù)、住院費(fèi)用以及患者滿意度的影響,提供高級別證據(jù)以支持該路徑臨床推廣。方法：按照納入排除標(biāo)準(zhǔn)收集60例患者,隨機(jī)分為路徑組和對照組。路徑組嚴(yán)格按照國家中醫(yī)藥管理局頒布的眩暈(后循環(huán)缺血)中醫(yī)臨床路徑住院流程及診療方案進(jìn)行,對照組住院流程及診療方案由主管醫(yī)生按臨床經(jīng)驗(yàn)執(zhí)行。記錄眩暈中醫(yī)癥候量表評分,眩暈程度分級及主要伴發(fā)癥狀,記錄患者住院天數(shù)及住院費(fèi)用,收集兩組患者中醫(yī)特色療法使用情況,進(jìn)行患者滿意度調(diào)查。出院后1月電話隨訪,統(tǒng)計(jì)兩組患者眩暈復(fù)發(fā)率及因眩暈再次住院率。綜合以上數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。結(jié)果：研究共納入60例患者,脫落2例,最終統(tǒng)計(jì)58例。經(jīng)治療,路徑組總有效率100%,高于對照組93.1%,但兩組比較無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后兩組中醫(yī)癥候量表評分及眩暈主癥均有顯著改善,但兩組間比較無統(tǒng)計(jì)學(xué)意義(P0.05),在眩暈主要伴發(fā)癥狀的改善方面,路徑組效果優(yōu)于對照組(P0.05)。路徑組平均住院費(fèi)用8471.309±1829.118元,平均住院天數(shù)9.59±2.413天,均低于對照組(10876.981±2581.560元,13.97±3.60天),且兩組比較差異顯著(P0.05)。在滿意度調(diào)查方面：對治療效果評價(jià),路徑組滿意度100%,對照組86.2%,P0.05；對住院費(fèi)用評價(jià),路徑組滿意度96.6%,對照組82.8%,P0.05；對療程評價(jià),路徑組滿意度100%,對照組86.2%,P0.05；對診療服務(wù)評價(jià),路徑組滿意度100%,對照組86.2%,P0.051對路徑方案的接受度,路徑組接受度100%,對照組86.2%,P0.05。中醫(yī)特色療法使用比較,路徑組使用2種以上特色療法29例,對照組使用2種以上中醫(yī)特色療法16例,P0.05。出院后1月隨訪兩組組眩暈復(fù)發(fā)率(路徑組10.3%,對照組27.6%,P0.05),再住院率(路徑組6.9%,對照組20.7%,P0.05)。結(jié)論：眩暈(后循環(huán)缺血)痰瘀阻竅證中醫(yī)臨床路徑療效顯著。該路徑方案可縮短患者住院天數(shù),降低住院費(fèi),節(jié)省醫(yī)療資源,提高醫(yī)療質(zhì)量。該路徑住院流程規(guī)劃合理,可全面提高患者對療程、療效、診療服務(wù)、住院費(fèi)用的滿意度。該路徑對本病長期預(yù)后有一定改善作用,且中醫(yī)特色突出,患者接受度高,適宜臨床推廣。
[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 鹵1829.118 yuan and 9.59 鹵2.413 days, respectively, which were lower than that of the control group (10876.981 鹵2581.560 yuan, 13.97 鹵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.
【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】：2016
【分類號】：R277.7

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