| Objective:To observe the differences between integrated traditional Chinese and Western medicine Clinical pathway management and conventional medical management of children with pneumonia, in terms of efficacy, expenses, usage rate of antibiotics, the extent of TCM treatment involvement, TCM syndromes types and TCM prescriptions:so as to understand the actual situation of clinical pathway implementation, and to provide the basis for its improvement and extension.Methods:This is a retrospective study, to choose 120 cases non-severe community acquired children pneumonia, be hospitalized in Guangdong Provincial Traditional Chinese Medical Hospital pediatric inpatient department during 2014-2015. Among which 60 cases are in clinical pathway group, implementing relevant physical examination, treatment and nursing work strictly referring to the standard forms of integrated traditional Chinese and Western medicine Clinical pathway, which formulated by Pediatric Department of Guangdong Provincial TCM Hospital;the rest of 60 cases are in conventional treatment group, be excluded from clinical pathway, using the conventional combination mode of traditional Chinese and Western medicine, implementing physical examination, treatment and nursing work according to the clinical experience of physicians. To compare the differences in terms of clinical efficacy, hospitalization days and hospitalization costs, usage rate of antibiotics, the extent of TCM treatment involvement, TCM syndromes types and TCM prescriptions between the two groups.Results:According to the research, there is no statistically difference(P>0.05) between the treatment duration[(5.350±1.603) d]and expence [(3433.87± 1130.79) yuan] in the hospital of the clinical pathway group and those [(5.167 ±1.815)d], [(3318.38±1454.27) yuan] of the conventional treatment group, which implies that clinical pathway cannot decrease the treatment duration and expence in hospital, clinical pathway group can improve patients’symptoms and signs in the 3rd after admission [(9.266±6.197) point], on the day of discharge [(16.783±3.719) point], and obvious effective rate (88.33%) were higher than those of the conventional treatment group [(7.183±6.072) point]、 [(14.100±5.996) point],56.67%(All P values<0.05), suggesting that clinical pathway group can better improve symptoms and signs of patients. It ’s more effective than conventional treatment group. There are 15 cases using antibiotics in clinical pathway group after admission(25%).which is significantly lower than that 26 cases of conventional treatment group(43.33%) (P<0.05), suggest that clinical pathway management can reduce the usage of antibiotics. The research results show that clinical pathway group compared with conventional therapy:oral decoction (96.67%vs.98.33%, P> 0.05), Chinese patent medicine (33.33%vs.36.67%, P> 0.05), traditional Chinese medicine injection(1.67%vs.3.33%, P>0.05), percutaneous intermediate frequency electrical stimulation (98.33%vs.95.00%, P> 0.05), traditional Chinese herb acupoint application (96.67%vs.93.33%, P> 0.05), acupoints infrared radiation (35.00%vs.21.70%, P> 0.05), pediatric manipulation (38.30%vs. 20.00%, P<0.05). It shows that most of TCM therapies take high degree of participation in both the two groups, while Chinese medicine injection has very low degree of utilization, and the clinical pathway group relatively better to implement pediatric manipulation therapy. The main syndromes type after admission both is phlegm-heat in the lung in the two groups, which clinical pathway group of 49 patients (81.67%), the conventional treatment group 39 cases (65.00%). There have 9 cases which are wind-heat syndrome, retention of phlegm-heat in the lung syndrome, external cold and internal heat syndrome in conventional treatment group;which do not meet the standard of pneumonia with dyspnea and cough syndrome. This conclusion suggests that clinical pathway helps to regulate pneumonia with dyspnea and cough syndrome differentiation. When admission the first Chinese medicine prescription mainly is Maxingshigan decoction, which the clinical pathway group have 30 cases accounted for 50.00%, the conventional treatment group have 17 cases accounted for 28.33%. The syndromes types when discharge mainly are phlegm-heat in the lung syndrome 44 cases (36.67%), stagnation of phlegm in lung syndrome 38 cases (31.67%). It suggests that stem of phlegm and phlegm-heat are the main pathological characteristics at children pneumonia recovery phase. When discharge the Chinese medicine prescription mostly choose to sooth the lung, clear up the phlegm or Anti-fever, such as san’ao decoction, er chen decoction, xiebai powder and so on. During treatment process self-prescription shows high frequency of occurrence. It happens 40 times when admission and discharge in conventional treatment group, while in clinical pathway group it happens 13 times. The result suggests that clinical pathway management helps to regulate the election of Chinese medicine prescription.conclusion:Clinical pathway of integrated traditional Chinese and Western medicine in Children pneumonia is effective. To apply children pneumonia clinical pathway management of integrated traditional Chinese and western medicine has more advantages on improving patients’symptoms, signs, and outcome when discharge. The pathway can reduce the usage of antibiotics, bring TCM treatment’s superiority into full play, help medical academic thought and clinical experience inheritance. While the pathway has no advantage to shorten the length of hospital stay and reduce medical expenses, which needs further research to explore the reason to optimize. And whether TCM therapies such as Chinese medicine injections, Evodia rutaecarpa apply to foot, Chinese medicine bathe be included into the pathway should be considered. In addition, the pathway management when applying should focus on solving the contradiction between standardization and personalization on TCM differentiation and Chinese medicine prescription. Children pneumonia clinical pathway of integrated traditional Chinese and western medicine remains to be refined and improved. |
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