Objective To analysis the clinical pathway management efficiency under different DRG groups, for a basis for further optimizing clinical pathway management. Methods The retrospective analysis method was used to compare the average length of stay, sub-average costs, and drug proportions of patients with different DRGs in the same clinical pathway. Shapiro-Wilk was used to detect the normality of the samples, t test was used to analyze measurement data conformed to the normal distribution, non-parametric test was used to analyze the abnormal distribution data, and enumeration data was detected by using chi-square test. Results For patients with a clinical pathway of bronchial pneumonia, patients with severe complications and concomitant symptoms had no significant difference in mean hospitalization and sub-costs, regardless of whether they completed or entered the clinical pathway ( P >0.05). For the other two DRG patients, the difference between the average length of stay, sub-average costs, and the proportion of medications for patients who completed the clinical pathway and withdrew from or did not complete the clinical pathway was significant(P<0.05). In the severe surgical group, the length of stay and average cost for patients who completed the clinical pathway were lower than those who exited or did not enter the clinical pathway(P<0.05). Conclusions Patients with different severity of DRGs should be cautious when they are enrolled in the clinical pathway.

Objective To analyze the differences in hospitalization days and costs of patients with acute cholecystitis in different departments or diagnosis related groups ( DRGs ), and provide scientific references for clinical medical management. Methods All the medical record homepages of the patients with acute cholecystitis were selected from a tertiary hospital from January 2017 to December 2017. The hospital analysis system of DRGs was used to calculate the classification results of DRGs. The Kruskal-Wallis H test was used to analyze the differences in hospital stays and costs between different DRGs or departments. Results The average length of stay was the shortest and the hospitalization cost in the department of hepatobiliary surgery was lower than other departments among patients with surgery and non-surgical(all P<0.05); The average length of stay at the department of hepatobiliary surgery was lower than the same other DRGs groups, namely the department of digestive medicine and gastrointestinal surgery(all P<0.05). There was no significant difference in the cost of " acute biliary tract disease with complications" between the various departments(P>0.05). The average cost in the department of hepatobiliary surgery was the lowest, and the average cost of gastrointestinal surgery was the highest in two DRGs of " acute biliary disease without complications and concomitant symptoms" and " laparoscopic cholecystectomy without common bile duct exploration" ( all P < 0.05 ). Conclusions Department of hepatobiliary surgery was better than other departments in the treatment of acute cholecystitis. Medical institutions should follow the principle of special treatment to reduce interdisciplinary patients and improve the professional competitiveness of the department.

Objective To compare and analyze the effect of minimally invasive percutaneous nephrolithotomy compare with traditional open surgical in treatment of kidney stones outcome. Methods Selected 120 patients with kidney stones from January 2009 to January 2014 in our hospital, all patients had complete clinical data, included 60 cases of renal sinus traditional lines pelvis lithotomy, established as the control group, and the remaining 60 routine minimally inva-sive percutaneous nephrolithotomy surgery, set up minimally invasive group, the operative time, blood loss, postoperative fistula time and hospital stay and complications were compared between two groups. Results 60 patients with invasive group homogeneity of puncture success and smooth gravel, stone successful in 58 cases, the success rate was 96.7%(58/60). Intraoperative complications pneumothorax, colon injury does not appear, one-time stone clearance rate was 80.0%(48/60). Stable vital signs after surgery, no nephrectomy, severe complications wound fistula, pneumothorax oc-curred. 4 cases of postoperative urinary tract infection sustained high fever, anti-infection cure. 1 case duodenal injury control group intraoperative peritoneal injury in 2 cases, 2 cases of postoperative fever, intestinal fistula, urinary tract infection in 8 cases. Operative time, blood loss, postoperative fistula compare the time and duration of hospitalization, of observation group improved significant than the control group, the difference was statistically significant (P<0.05 or P<0.01). Conclusion Minimally invasive percutaneous nephrolithotomy in the treatment of kidney stones with less trau-ma, less bleeding, fewer complications, shorter hospital stays and can be worthy of promotion and application.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.