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临床路径应用于子宫肌瘤手术患者临床诊治的Meta分析
作者:高艳 杨秋杰 
单位:中国医科大学附属四院外科
关键词:临床路径 子宫肌瘤 临床对照研究 Meta分析 
分类号:
出版年·卷·期(页码):2013·41·第七期(437-441)
摘要:

目的: 采用偱证医学Meta分析的方法以探讨临床路径对子宫肌瘤手术患者临床诊治的影响。方法: 计算机检索万方、维普、CNKI及中国生物医学等中文数据库,全面收集国内有关临床路径应用于子宫肌瘤手术患者诊治的临床对照研究,汇总数据采用RevMan 5.1.6和STATA 10.0进行分析,两组之间差异采用标准均数差(standardized mean difference,SMD)或优势比(odds ratio,OR)及其95%可信区间(95% confidence intervals,95%CI)描述。结果: 严格根据纳入和排除标准,最终纳入11个临床对照研究,包括998例子宫肌瘤手术患者,其中临床路径组498例,对照组500例。Meta分析结果表明:与对照组相比,临床路径观察组平均住院时间短(SMD= -1.60, 95%CI= -1.75~-1.45, P<0.00001),平均住院费用低(SMD= -1.17, 95%CI= -1.40~-0.95, P<0.00001),且患者满意度高(OR=7.88, 95%CI=4.09~15.16, P<0.00001),两组之间差异均有统计学意义。结论: 临床路径应用于子宫肌瘤手术患者,可以明显缩短平均住院时间,降低住院费用。由于纳入研究质量及数量有限,本研究结论尚需大样本高质量临床研究进行证实。

[Abstract] Objective: This study aims to investigate the application of clinical pathway for patients with hysteromyoma by conducted a systematic review and meta-analysis. Methods: WanFang, CNKI, VIP and CBM databases were searched extensively to identify relevant clinical controlled trials. Data were analyzed by RevMan 5.1.6 and STATA 10.0 softwares. Results were described as standardized mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CI). Results: Finally, a total of 11 clinical controlled trials involving 998 hysteromyoma patients were included in this systematic review, including 498 patients in clinical pathway group and 500 patients in control group. Meta-analysis showed the case group got a shorter average length of stay, less hospital cost and higher satisfaction than the control group(SMD= -1.60, 95%CI= -1.75~-1.45, P<0.00001; SMD= -1.17,95%CI= -1.40~-0.95, P<0.00001; OR=7.88, 95%CI=4.09~15.16, P<0.00001, respectively), there was statistically significant differences between this two group. Conclusion: The present data suggests that clinical pathway may reduce the cost of care, cut the average length of stay significantly and have good improvement of clinical effect for patients with hysteromyoma. Further well-designed randomized controlled trials are needed to confirm or adjust current conclusions.

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