Coronary atherosclerotic heart disease clinical pathway standard inpatient procedure.
(A) Applicable objects.
First diagnosis of coronary atherosclerotic heart disease (ICD-10:I25.1)
Coronary artery bypass grafting (ICD-9-CM-3: 36.1)
(ii) Diagnostic basis.
According to the Clinical Diagnosis and Treatment Guide-Cardiovascular Surgery Division (edited by the Chinese Medical Association, People’s Health Publishing House)
1.History: There may be a history of angina attack.
2, clinical manifestations: there may be physical labor, emotional excitement or full meal in the precordial region suffocation, discomfort, arrhythmia, etc.
3, auxiliary examination: electrocardiogram and electrocardiogram exercise test, echocardiography, coronary angiography, etc.
(iii) The basis for selecting the treatment plan.
According to the Clinical Technique Operation Specification – Cardiovascular Surgery Sub-volume (edited by Chinese Medical Association, People’s Military Medical Press)
Coronary artery bypass grafting (ICD-9-CM-3:36.1).
(iv) Standard hospitalization days 11-18 days.
(V) Entry pathway criteria.
1. The first diagnosis must be in accordance with ICD-10: I25.1 coronary atherosclerotic heart disease code.
2.Coronary angiography has been completed and the diagnosis is clear.
3.There are indications for the procedure and no contraindications.
4.Age ≤ 70 years old.
5, cardiac function ≤ Class III or EF ≥ 45%.
6.When the patient has other disease diagnosis at the same time, but does not need special treatment during hospitalization nor affect the implementation of the clinical pathway process of the first diagnosis, he/she can enter the pathway.
(F) Preoperative preparation 1-3 days.
1. Required examination items.
(1) Laboratory tests: blood routine + blood group, urine routine, full blood biochemistry (blood electrolytes + liver and kidney function + blood glucose), coagulation function, screening for infectious diseases (hepatitis B, hepatitis C, syphilis, AIDS, etc.), blood gas analysis.
(2) Chest X-ray, electrocardiogram, echocardiogram.
(3) Coronary angiography.
(2) Optional tests according to the patient’s specific conditions: such as cardiac enzymes, blood troponin, chest CT, pulmonary function tests, carotid vascular ultrasound, sampling vascular ultrasound, abdominal ultrasound, etc.
(vii) Preventive antibacterial drug selection and timing of use.
Antimicrobial drug use: follow the “Guidelines for Clinical Application of Antimicrobial Drugs” (Health Medical Development [2004] No. 285), and decide the selection and timing of antimicrobial drug use according to the patient’s condition.
(H) The day of surgery is the 2nd-4th day of hospital admission.
1.Mode of anesthesia: general anesthesia.
2.Intraoperative decision on the use of extracorporeal circulation assistance according to the situation.
3.Surgical implant: sternal fixation wire.
4.Intraoperative medication: routine medication for anesthesia and extracorporeal circulation.
5.Blood transfusion and blood products: depending on the intraoperative situation.
(ix) Postoperative hospital recovery 9-14 days.
1.Transfer to guardianship ward after surgery and continue monitoring treatment.
2.Transfer back to general ward after stable condition.
3.Checkup items that must be reviewed: blood routine, blood electrolytes + liver and kidney function + blood sugar, chest X-ray, electrocardiogram, echocardiogram.
4.Use of antibacterial drugs: according to the “Guidelines for Clinical Application of Antibacterial Drugs” (Health Medical Development [2004] No. 285), and decide the selection and use time of antibacterial drugs according to the patient’s condition.
5.Anti-platelet therapy: decide the timing of medication according to the patient’s condition.
(X) Discharge criteria.
1.The patient’s general condition is good, the body temperature is normal, and the review program is completed.
2.Good incision healing: drainage tube removed, no infection in the wound.
3.No complications that require hospitalization.
(XI) Variation and cause analysis.
1.Preoperative antiplatelet drugs such as aspirin and clopidogrel need to be discontinued for 5-6 days, and the operation time was postponed accordingly, resulting in prolonged hospital stay.
2, perioperative complications and other causes of prolonged hospitalization days and increased costs.
3.Selective surgical consumables: Different endosseous and consumables are used due to different conditions, resulting in differences in hospitalization costs.
4.Cause analysis of variation approved by physicians.
5. Other patient-side reasons, etc.