急性单纯性阑尾炎住院临床路径遵循情况分析

利用2010年全国城镇基本医疗保险参保住院患者医疗服务利用调查数据，对急性单纯性阑尾炎住院手术患者临床诊疗措施的实际使用情况与该病的标准临床路径进行对比分析。平均住院日比临床路径要求的7天约高出1天，其中41.9%手术病例住院天数超出了标准住院日；约47.5%患者未在入院当天急诊手术；18个平均使用率在40%以上的检查项目中，有7个项目不在临床路径规定范围内；99.8%病例在手术中使用过全身抗感染类药，且67%的患者同时使用了2种及2种以上抗菌素。急性单纯性阑尾炎的实际诊疗措施和标准临床路径存在着较大的差异，住院流程有待于进一步优化，住院检查检验项目和抗菌药物的使用需要制订更为细致且可操作的指导原则，并强化监管。

Analysis of the Clinical Pathway Following to the Acute Simple Appendicitis Inpatients

The actual clinical use of diagnostic and therapeutic measures was comparatively analyzed in the acute simple appendicitis inpatients with its clinical pathways using the data from the National Medical Service Utilization Survey for the Inpatients with Basic Health Insurance in 2010. The average length-of-stay (LOS) was about one day more than the standardized LOS, and the LOS of more than 41% of the inpatients was higher than standardized LOS; About 47.5% of the inpatients did not took their operations in the first day as the clinical pathway required; Among the 18 diagnostic measures whose use rates were above 40%, 7 were not included in the clinical pathway; About 99.8% of the inpatients used anti-infective drugs in their operations, and 67% of them used 2 kinds or more. There was great disparity between the actual use of diagnostic and therapeutic measures and the standardized clinical pathway, which means the admission process needs further optimization and the use of diagnostic and therapeutic measures and anti-infective drugs needs more detailed guidance and surveillance.