微信MDT在继发性甲状旁腺功能亢进症围手术期的临床应用

Clinical application of WeChat MDT in the perioperative period of secondary hyperparathyroidism

目的观察微信群支持的多学科协作团队(multi-disciplinary team,MDT)诊疗模式的流程和方案在继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)围手术期中的应用效果。方法选取2017年7月至2019年10月湖南省人民医院、祁东县人民医院住院治疗的80例SHPT患者,按照完全随机原则分为MDT组(40例)与对照组(40例),其中MDT组女21例,男19例,年龄(48.80±9.08)岁,范围为26~74岁;对照组女23例,男17例,年龄(47.90±8.89)岁,范围为24~74岁。对照组予常规治疗方案,MDT组在此基础上实施微信MDT流程,比较2组的围手术期术前准备时间、手术时间、术中出血量、术后拔管时间、持续性全段甲状旁腺激素(intact parathyroid hormone,iPTH)及血钙、血磷水平,同时比较2组术后并发症情况及患者满意度。本研究数据均应用SPSS 23.0统计软件进行数据分析。结果MDT组的术前准备时间(4.35±1.12)d、手术时间(130.00±32.58)min、术中出血量(15.75±7.89)ml、术后拔管时间(3.80±0.82)d均显著低于对照组的术前准备时间(6.86±1.85)d、手术时间(162.57±41.65)min、术中出血量(60.75±11.5)ml、术后拔管时间(5.97±1.25)d(P<0.05);术后1周MDT组的iPTH(20.86±1.52)pg/ml及血钙水平(2.23±0.24)mmol/L均显著低于对照组的iPTH(103.47±8.27)pg/ml及血钙水平(2.87±0.21)mmol/L(P<0.05)),同时MDT组的血磷水平(1.52±0.56)mmol/L显著高于对照组的血磷水平(1.18±0.25)mmol/L(P<0.05);MDT组患者的并发症发生人次(20人次)显著低于对照组患者的并发症发生人次(48人次)(P<0.05);且MDT组治疗的满意度(100.00%)显著优于对照组(80.00%)(P<0.05)。结论微信MDT诊疗流程及治疗方案安全有效,能有效缩短手术时间,降低手术风险,同时减少术后并发症,增加患者满意度,可进一步在临床推广。

Objective To observe the application effect of the multi-disciplinary team(MDT)process and program supported by WeChat group in the perioperative period of secondary hyperparathyroidism(SHPT).Methods A total of 80 SHPT patients who were hospitalized in Hunan Provincial People’s Hospital and Qidong County People’s Hospital from Jul.2017 to Oct.2019 were selected and divided into MDT group(40 cases)and control group(40 cases)according to the principle of complete randomization.In MDT group,there were 21 females and 19 males,aged(48.80±9.08)years old,ranging from 26 to 74 years;in the control group,there were 23 females and 17 males,aged(47.90±8.89)years old,ranging from 24 to 74 years.The control group were given a conventional treatment plan,and the MDT group were implemented with the WeChat MDT process on this basis.The perioperative preparation time,operation time,intraoperative blood loss,postoperative extubation time,and continuous full parathyroid were compared between the two groups.The levels of intact parathyroid hormone(iPTH)and blood calcium and phosphorus were compared with the postoperative complications and patient satisfaction in the two groups.The data in this study were analyzed using SPSS 23.0 statistical software.Results The preoperative preparation time(4.35±1.12)d,operation time(130.00±32.58)min,intraoperative blood loss(15.75±7.89)ml,and postoperative extubation time(3.80±0.82)d in the MDT group were significantly lower than the preoperative preparation time of the control group(6.86±1.85)d,operation time(162.57±41.65)min,intraoperative blood loss(60.75±11.5)ml,postoperative extubation time(5.97±1.25)d(P<0.05)1 week after operation,the iPTH(20.86±1.52)pg/ml and blood calcium level(2.23±0.24)mmol/L of the MDT group were significantly lower than those of the control group(103.47±8.27)pg/ml and blood calcium level(2.87±0.21)mmol/L(P<0.05),meanwhile the blood phosphorus level of the MDT group(1.52±0.56)mmol/L was significantly higher than the blood phosphorus level of the control group(1.18±0.25)mmol/L(P<0.05).The number of complications in the MDT group(20 cases)was significantly lower than the number of complications in the control group(48 cases)(P<0.05);and the satisfaction of treatment in the MDT group(100.00%)was significantly better than that of the control group(80.00%)(P<0.05).Conclusion The WeChat MDT diagnosis and treatment process and treatment plan are safe and effective,which can effectively shorten the operation time,reduce the operation risk,reduce postoperative complications,and increase patient satisfaction.It can be further promoted in the clinic.