COVID-19疫情期基于在线防控管理模式的多学科协作诊疗团队对川崎病并发冠状动脉损害患儿门诊随访应用

Application of multi-disciplinary team based on prevention and control management mode under online in outpatient follow-up of children with Kawasaki disease and complicated with coronary artery lesion during COVID-19 epidemic period

目的探讨新型冠状病毒疾病(COVID-19)疫情期(以下简称为疫情期),基于在线防控管理模式(PCM-online)的多学科协作诊疗团队(MDT)对川崎病并发冠状动脉损害(CAL)患儿(受试儿)门诊应用的有效性和安全性。方法选择在成都市妇女儿童中心医院儿童心血管内科接受长期治疗,并且在2020年1月21日至2月19日疫情期,需接受复诊的35例受试儿为研究对象。通过组建涵盖临床医疗、护理、心脏超声、药学、营养学、心理学等学科的MDT,采取“互联网+”形式,对需接受复诊受试儿家属进行川崎病及CAL等在线咨询,心理干预,用药、营养饮食与家庭护理指导,以及COVID-19相关知识宣教与外出就医防护措施指导。对部分情绪相对紧张、焦虑的受试儿家属,采用《90项症状自评量表(SCL-90)》进行心理测评,并根据测评结果进行在线心理疏导。基于PCM-online的MDT干预前、后,采用医院自制满意度调查表,对其家属的满意度进行调查,对SCL-90各因子评分及满意度评分进行比较,采用配对t检验。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。结果①本组35例受试儿,接受基于PCM-online的MDT管理后,取消现场门诊复诊者为26例,避免至少52人次外出就医感染严重急性呼吸窘迫综合征冠状病毒2(SARS-CoV-2)风险;9例因病情需要进行现场复诊。②基于PCM-online的MDT对11例受试儿家属采取SCL-90进行心理测评的结果均呈阳性,经心理疏导后,SCL-90焦虑、恐惧因子评分分别为(1.38±0.44)分与(1.23±0.42)分,均较心理疏导前的(1.64±0.25)分与(1.38±0.13)分显著降低,并且差异均有统计学意义(t=3.285、2.883,P=0.010、0.021)。③采取基于PCM-online的MDT干预后,35例受试儿家属满意度评分为(98.6±1.4)分,显著高于干预前的(94.3±4.7)分,并且差异有统计学意义(t=4.369,P<0.001)。结论疫情期,基于PCM-online的MDT可达到疫情防控与促进受试儿康复目的,是低风险、低成本、高效率的有效防控模式。由于本研究纳入样本量相对较小,研究时间相对较短,该模式是否值得临床推广应用,仍有待进一步研究、证实。

Objective To explore effect and safety of multi-disciplinary team(MDT)based on prevention and control management mode under online(PCM-online)in outpatient follow-up of children with Kawasaki disease and complicated with coronary artery lesion(CAL)during the epidemic outbreak period of corona virus disease 2019(COVID-19).Methods From 21 January,2020 to 19 February,2020,a total of 35 children with Kawasaki disease and complicated with CAL who received long-term treatment in the Department of Cardiovascular of Chengdu Women′s and Children′s Central Hospital and needed to go to the hospital for referral during epidemic outbreak period were selected as research subjects.By setting up an MDT based on PCM-online covering medical care,nursing,cardiac ultrasound,pharmacy,nutrition and psychology,and adopting the"Internet+"method,online consultations were provided to children with Kawasaki disease and complicated with CAL who needed to go to the hospital for referral,such as professional consultation of Kawasaki disease with CAL,psychological intervention,guidance on medication,nutrition diet and home care,and health education of COVID-19 and guidance on protective measures when going out for medical treatment.For some family members of children with relatively tense and anxious emotions,the Symptom Checklist 90(SCL-90)was used for psychological evaluation,and online psychological counseling was conducted based on the psychological evaluation results.A self-made satisfaction questionnaire of our hospital was used to investigate the satisfaction of family members of children before and after intervention of MDT based on PCM-online.The scores of SCL-90 factors and satisfaction scores of family members of the children before and after intervention of MDT based on PCM-online were compared by paired t test.The procedures followed in this study were in accordance with the requirements of newly revised World Medical Association Declaration of Helsinki in 2013.Results①Among the 35 children with Kawasaki disease and complicated with CAL,26 children canceled on-site outpatient visits after intervention of MDT based on PCM-online,thus avoiding the risk of infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)at least 52 people going out for medical treatment;9 patients required on-site follow-up due to their pathogenetic conditions.②A total of 11 cases of family members of children received SCL-90 for psychological evaluation by mental intervention subgroup in MDT,and all of them were with positive results.After receiving psychological counseling in mental intervention subgroup,anxiety and fear factor scores in SCL-90 of the family members of these 11 children were(1.38±0.44)scores and(1.23±0.42)scores,respectively,which were higher than those before receiving psychological counseling(1.64±0.25)scores and(1.38±0.13)scores,and both the differences were statistically significant(t=3.285,2.853;P=0.010,0.024).③After intervention of MDT based on PCM-online,the satisfaction score of 35 children′s family members was(98.6±1.4)scores,which was significantly higher than(94.3±4.7)scores before intervention,and the difference was statistically significant(t=4.369,P=0.031).Conclusions During COVID-19 epidemic period,intervention of MDT based on PCM-online achieves the purpose of epidemic prevention and control of COVID-19 and promotes the recovery of children with Kawasaki disease and complicated with CAL which is a new model for prevention and control of COVID-19 with low-risk,low-cost and high-efficiency under severe epidemic situation.Due to the relatively small sample-size and relatively short period of time enrolled in this study,whether this model is worthy of clinical popularization and application remains to be further studied and confirmed.