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目的观察晚期血吸虫病(晚血)肝纤维化治疗临床路径的实施效果。方法选择符合临床路径治疗入选标准的晚血患者,制定并实施晚血抗肝纤维化治疗临床路径方案。比较晚血患者经实施临床路径治疗前后的住院天数、住院总费用、个人承担费用,以及门静脉内径、肝纤维化4项指标[透明质酸(HA)、层黏蛋白(LN)、Ⅲ型胶原前肽(P(P)、Ⅳ型胶原(CIV)]及血清酶活性3项[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和γS谷氨酰转肽酶(γ氨酰转)]等。结果共有142例晚血患者纳入抗肝纤维化临床路径治疗。患者在实施临床路径治疗后,住院总费用和患者个人承担费用分别下降11.2%和16.1%(t=6.310、4.326,P均<0.05);HA均值2倍于正常值,阳性率由70.4%升至83.1%,CC、γC.1阳性率分别为64.1%、28.9%。结论临床路径可大幅度降低晚血患者治疗费用。但晚血患者体内仍持续存在着纤维增生活跃和慢性肝损害现象,提示在临床上仍需寻找更为有效的晚血治疗方法。
Objective To observe the clinical effect of clinical treatment of advanced hepatic fibrosis with schistosomiasis (late blood). Methods Patients with late blood that meet the criteria of clinical pathology were enrolled in the study and were enrolled in the study. The clinical pathway of anti-liver fibrosis therapy was developed and implemented. The hospitalization days, hospitalization costs, individual commitment costs, and portal vein diameter and liver fibrosis were compared among four groups of patients with late blood before and after the implementation of the clinical pathway (HA, LN, (P (P), type IV collagen (CIV)], and three serum enzyme activities [alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γS glutamyl transpeptidase (γ-aminotransferase)], etc. Results A total of 142 patients with late blood were included in the anti-hepatic fibrosis clinical pathway.The total cost of hospitalization and patient commitment decreased by 11.2% and 16.1% (t The positive rates of CC and γC.1 were 64.1% and 28.9% respectively.Conclusion The clinical pathways can be greatly improved Reduce the cost of treatment of patients with late blood, but patients with late blood persist in the body of active and chronic fibrovascular fibrosis, suggesting that in clinical still need to find more effective treatment of late blood.