多学科团队管理对先天性脐膨出结局的影响

The effects of multi-disciplinary team management on the outcome in neonates with omphalocele

目的探讨多学科团队(multidisciplinary team,MDT)管理对先天性脐膨出患儿结局的影响。方法采用回顾性非随机对照临床研究方法,选择2010年12月至2017年12月广州市妇女儿童医疗中心新生儿外科收治的先天性脐膨出新生儿,根据MDT成立时间,2014年12月前收治、无MDT管理的患儿为对照组,2014年12月后收治的患儿为MDT管理组。采用X^2检验、t检验或秩和检验比较两组患儿一般特征及结局,多因素分析采用Logistic回归分析。结果共纳入91例先天性脐膨出患儿,对照组50例,MDT管理组41例。MDT管理组与对照组比较死亡率降低[2.4%(1/41)比18.0%(9/50)],巨大型脐膨出患儿机械通气时间中位数缩短(18.3h比41.7 h),差异均有统计学意义(P<0.05);两组肠外营养时间和住院时间差异均无统计学意义(P>0.05).调整相关混杂因素后,对照组死亡风险约为MDT管理组的54倍(OR=54.19,95%CI 2.64~1113.49,P<0.05)。结论MDT管理有助于降低先天性脐膨出患儿死亡风险。

Objective To study the effect of multi-disciplinary team(MDT)management on the outcome in neonates with omphalocele.Method A retrospective non-randomized controlled clinical study was conducted.Neonates who were diagnosed as omphalocele and admitted to the surgical neonatal intensive care unit of the Guangzhou Women and Children Medical Center from December 2010 to December 2017 were collected.Because MDT was established in December 2014,infants were assigned into non-MDT group and MDT group according to their dates of admission.The characteristics and outcomes between non-MDT group and MDT group were compared using X2,t-test or rank-sum test.Multivariate analysis was performed by Logistic regression.Result A total of 91 neonates were included in the study,50 were in non-MDT group and 41 were in MDT group.The mortality in MDT group(2.4%,1/41)was lower than that in non-MDT group(18.0%,9/50),the difference was statistically significant(P<0.05).The median time of mechanical ventilation of giant omphalocele in non-MDT group(18.3 hours)was longer than that in MDT group(41.7 hours),the difference was also statistically significant(P<0.05).After adjusting for the associated confounding risk factors,the risk of death in non-MDT group was 54 times higher than that in MDT group(OR=54.19,95% CI 2.64~1113.49,P<0.05).Conclusion There was significant association between the MDT management and the decreased risk of death of omphalocele.