多准则决策分析构建儿童重症麻疹集束化管理的研究

Effect of Multi-criteria Decision Analysis to Construct Bundle Treatment of Severe Measles in Children

目的探讨多准则决策分析在儿童重症麻疹集束化管理中的作用。方法采用与历史对照的前瞻性研究,将2011年6月至2013年12月徐州市传染病医院感染性疾病科收治的20例重症麻疹患儿作为历史对照组,将2014年1月至2015年10月收治的25例重症麻疹患儿为观察组,由医护人员组成多准则决策分析小组,选取集束化治疗措施与常规治疗措施组成捆绑式治疗方案,将多准则决策分析应用于重症麻疹集束化管理中。比较两组治疗前小儿危重病例评分(PCIS评分)及治疗期间气管插管率、多器官功能衰竭(MODS)发生率、住呼吸重症监护室(RICU)时间等方面的差异。结果观察组与对照组资料前PCIS评分无统计学差异,但观察组治疗期间气管插管率明显下降(45.00%VS 12.00%,P=0.032),MODS发病率明显下降(40.00%VS 8.00%,P=0.027),而且住RICU时间明显缩短[(17.92±4.79)d VS(14.48±3.98)d,P=0.012]。结论多准则决策分析构建儿童重症麻疹集束化管理,提高了决策的科学性,降低了治疗期间气管插管率和MODS发生率,减少了住RICU时间,改善患儿临床结局和预后,值得推广。

Objective To discuss the effect of multi-criteria decision analysis in the bundle treatment of severe measles in children. Methods In the prospective observational and historical control study,twenty children with severe measles from June 2011 to December 2013 were set as control group,and twenty-five children with severe measles from January 2014 to October 2015 were assigned as observation group to receive multi-criteria decision analysis（ MCDA） managed by health care professionals for bundle treatment plus conventional therapy. Comparison the differences of pediatric clinical illness score（ PCIS） before treatment,rate of endotracheal intubation during treatment,multiple organ dysfunction syndrome（ MODS） incidence and respiratory intensive care unit（ RICU） stay were performed between the two groups. Results PCIS score before treatment of the observation group and the control group was not statistically significant（ P〈0. 05）,but the rate of endotracheal intubation during treatment（ 45. 00% VS 12. 00%,P = 0. 032）,MODS incidence（ 40. 00% VS 8. 00%,P = 0. 027）,duration of ICU stay [（ 17. 92 ± 4. 79） d VS（ 14. 48 ± 3. 98）d,P = 0. 012] was significantly decreased compared with the control group（ P〈0. 05）. Conclusion Application of multi-criteria decision analysis in the bundle treatment of severe measles in children could improve the scientificity of decision and reduce the rate of endotracheal intubation during treatment,MODS incidence and ICU length of stay. Therefore,MCDA is worthy to be popularized to improve the clinical outcome and prognosis of the severe measles in children.