Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, 68135 Mannheim, Germany.
Langenbecks Arch Surg. 2010 Jan;395(1):11-7. doi: 10.1007/s00423-009-0551-3.
Standardization of care is essential for improving outcome of kidney transplantation (KT). Clinical pathways (CPs) are known to standardize and improve perioperative care for a number of interventions. In transplantation medicine, however, pertinent evidence is very limited. This study evaluates effects of a CP on quality of care in KT.
Consecutive patients (n=32) undergoing KT between July 2006 and August 2007 who were treated with a CP were compared to patients (n=44) treated without CP between January 2005 and June 2006. Several quality indicators regarding process and outcome were compared between groups.
Quality of care was significantly higher in the CP group for the following indicators: timely removal of central venous catheters, wound drains, and Foley catheters and control of cyclosporine levels, respiratory exercising, and pain control. Median stay decreased non-significantly from 21.4 to 18.3 days. There was significantly less delayed graft function in the CP group. All other outcome indicators showed no significant differences.
Implementation of a CP for KT improves the quality of perioperative treatment by standardizing care. Regarding effects on outcome, no clear conclusion can be drawn. We recommend that large randomized studies are conducted to evaluate the latter issue.
规范护理对于改善肾移植（KT）的结果至关重要。临床路径（CPs）已被证明可以规范和改善许多干预措施的围手术期护理。然而，在移植医学中，相关证据非常有限。本研究评估了 CP 对 KT 护理质量的影响。
将 2006 年 7 月至 2007 年 8 月期间接受 CP 治疗的连续 32 例 KT 患者与 2005 年 1 月至 2006 年 6 月期间未接受 CP 治疗的 44 例患者进行比较。比较两组之间关于过程和结果的几个质量指标。
CP 组在以下指标的护理质量明显更高：及时移除中心静脉导管、引流管和 Foley 导管以及控制环孢素水平、呼吸锻炼和疼痛控制。中位住院时间从 21.4 天缩短至 18.3 天，但无统计学意义。CP 组的延迟移植物功能明显减少。其他所有结果指标均无显著差异。
为 KT 实施 CP 可以通过规范护理来提高围手术期治疗的质量。关于对结果的影响，无法得出明确的结论。我们建议进行大规模的随机研究来评估后者。
