Clinical pathway for the surgical treatment of bronchiectasis
A. Standard inpatient procedure of the clinical pathway for the surgical treatment of bronchiectasis (a) Applicable objects. The first diagnosis of bronchiectasis (ICD-10: J47) Pulmonary segmental resection/ lobectomy/ compound lobectomy/ total pneumonectomy (ICD-9-CM-3: 32.39/32.49/32.59). (ii) Diagnostic basis. According to the Clinical Diagnosis and Treatment Guideline – Thoracic Surgery Book (Li Xuejun, Department of Cardiothoracic Surgery, Guangdong Second People’s Hospital, China)
A. Standard inpatient procedure of clinical pathway for surgical treatment of bronchiectasis
(A) Applicable objects.
First diagnosis of bronchiectasis (ICD-10: J47)
Pulmonary segmental resection/ lobectomy/ compound lobectomy/ total pneumonectomy (ICD-9-CM-3: 32.39/32.49/32.59).
(ii) Diagnostic basis.
According to the Clinical Diagnosis and Treatment Guide-Thoracic Surgery Sub-volume (edited by the Chinese Medical Association, People’s Health Publishing House).
1.Clinical symptoms: recurrent cough, coughing pus sputum, hemoptysis, chronic infection or poisoning symptoms.
2.Signs: croup or wet rales can be heard in more severe lung infections or hemoptysis. When the lesion involves both lungs, there may be dyspnea and cyanosis, and chronic hypoxic changes such as pestle-like fingers (toes) can be seen in those with longer disease duration.
(3) Adjunctive examination: imaging examination shows abnormal changes of bronchial dilatation.
(iii) The basis for selecting the treatment plan.
According to the Clinical Diagnosis and Treatment Guide-Thoracic Surgery Sub-volume (edited by Chinese Medical Association, People’s Health Publishing House).
Pulmonary segmental resection, lobectomy, compound lobectomy, and total pneumonectomy were performed.
(D) The standard hospitalization day is ≤18 days.
(V) Entry pathway criteria.
1.The first diagnosis must meet the ICD-10: J47 bronchiectasis disease code.
2. When the patient has other disease diagnoses at the same time, but does not require special treatment during outpatient treatment and does not affect the implementation of the clinical pathway process for the first diagnosis, he/she can enter the pathway.
(F) Preoperative preparation ≤ 5 days.
1. Required examination items.
(1) Routine blood, routine urine, routine stool + occult blood test, sputum culture + drug sensitivity, 24-hour sputum volume.
(2) Coagulation function, blood group, liver function measurement, kidney function measurement, electrolytes, infectious disease screening (hepatitis B, hepatitis C, AIDS, syphilis, etc.).
(3) electrocardiogram, pulmonary function.
(4) Imaging tests: chest X-ray, chest CT.
(2) Optional items according to the patient’s condition: glucose determination, tuberculosis-related tests, fiberoptic bronchoscopy, echocardiography, CTPA, myocardial nuclear scan, Holter, 24-hour ambulatory blood pressure monitoring, cardiac ultrasound, arterial blood gas analysis, etc.
3. Preoperative airway preparation.
(vii) Prophylactic antimicrobial drug selection and timing of use.
1. Follow the “Guidelines for Clinical Application of Antimicrobial Drugs” (Wei Medical Development [2004] No. 285), and decide the selection and timing of antimicrobial drugs according to the patient’s condition. If the infection is suspected, corresponding microbiological examination is required and drug sensitivity test is done if necessary.
2. Refer to the results of sputum culture and drug sensitivity test to apply antibacterial drugs to control the infection.
(H) The day of surgery is admission ≤ 6 days.
1. Anesthesia: general anesthesia with double-lumen tracheal intubation.
2.Intraoperative medication: antibacterial drugs.
3.Blood transfusion: depending on the intraoperative situation. Blood type identification, antibody screening and cross-combination are required before transfusion.
(ix) Postoperative hospital recovery ≤ 12 days.
1.Checkup items that must be reviewed: blood routine, liver function measurement, kidney function measurement, electrolytes, chest X-ray, etc.
2.Postoperative application of antibacterial drugs: in accordance with the Guidelines for the Clinical Application of Antibacterial Drugs (Health Care Development [2004] No. 285). The duration of antimicrobial drugs and the type of drugs can be extended and changed depending on the change of the condition. If the infection is suspected, the corresponding microbiological examination should be done, and drug sensitivity test should be done if necessary.
(J) Discharge criteria.
1.The patient’s condition is stable, the body temperature is normal, the surgical incision is healing well, and the vital signs are stable.
2, no complications and/or comorbidities requiring hospitalization.
(XI) Variation and cause analysis.
1.The presence of comorbidities affecting the surgery and the need for relevant diagnosis and treatment.
2.Postoperative complications such as pulmonary infection, respiratory failure, cardiac failure, hepatic and renal failure, bronchopleural fistula, etc., requiring extended treatment.