基于多学科合作在创建下肢慢性溃疡伤口规范化治疗的应用

Application of Multidisciplinary Cooperation in Standardized Treatment of Chronic Lower Extremity Ulcer

目的研究基于多学科(MD)合作在创建下肢慢性溃疡伤口规范化治疗的应用价值。方法选取2018年10月至2019年9月在复旦大学附属华山医院收治的下肢慢性溃疡患者536例为研究对象,随机分为试验组(n=270)和对照组(n=266),对照组予以单一科室治疗管理模式,试验组采用MD合作管理模式,对两组患者干预前和干预后疼痛数字评分(NRS)、溃疡创面面积及渗出液中基质金属蛋白酶-1(MMP-1)、MMP-9、金属蛋白酶组织抑制剂-1(TIMP-1)方面进行比较,并观察两组患者的总治愈率及24周内总复发率。结果干预2、4、6、8、10、12周后,在不同时间点试验组患者NRS评分均低于对照组(P<0.05);试验组患者溃疡创面面积较对照组小(P<0.05)。干预12周后,试验组患者渗出液中MMP-1、MMP-9、TIMP-1低于对照组(P<0.05),试验组患者总治愈率高于对照组(P<0.05)。干预24周后,试验组患者总复发率低于对照组(P<0.05)。结论基于MD合作模式应用于下肢慢性溃疡伤口规范化治疗中效果较好,可有效促进创面愈合,缩短换药病程,提高总治愈率。

Objective To study the application value of multidisciplinary(MD)cooperation in standardized treatment of chronic lower extremity ulcer.Methods A total of 536 patients with chronic lower extremity ulcer admitted to Huashan Hospital Affiliated to Fudan University from October 2018 to September 2019 were enrolled and randomly divided into experimental group(n=270)and control group(n=266).The control group received single department treatment management mode,while the experimental group received MD cooperation management mode.The numerical rating scale(NRS)scores of pain,ulcer area,matrix metalloproteinase-1(MMP-1),matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP-1)in exudate before and after intervention were compared between the two groups.The total cure rate and total recurrence rate within 24 weeks were observed.Results After 2,4,6,8,10 and 12 weeks of intervention,the NRS scores in the experimental group were lower than those in the control group at different time points(P<0.05).The experimental group had smaller ulcer area than the control group(P<0.05).After 12 weeks of intervention,MMP-1,MMP-9 and TIMP-1 in the exudate of the experimental group were lower than those in the control group(P<0.05).The total cure rate of the experimental group was higher than that of the control group(P<0.05).The total recurrence rate within 24 weeks in the experimental group was lower than that in the control group(P<0.05).Conclusion The application of MD cooperation mode has a good effect in the standardized treatment of chronic lower extremity ulcer,which can effectively promote wound healing,shorten the duration of dressing changes,and increase the total cure rate.