多学科联合会诊诊疗模式在青海地区慢性创面中的应用研究

Application of multi-disciplinary team model in chronic wounds in Qinghai area

目的探讨多学科联合会诊(MDT)诊疗模式在青海地区慢性创面治疗中的应用和研究。方法选择2017年6月至2020年6月于青海省人民医院就诊的慢性创面患者300例,按照随机数字表法分为观察组与对照组,每组150例,观察组给于MDT诊疗模式治疗和护理,对照组给于普通治疗和护理,观察2组患者治疗前后创面愈合情况、焦虑、抑郁状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)评分]、住院时间和住院费用、创面评估[创面床评估系统(WBS)、Bate-Jensen伤口评估系统(BWAT)、伤口评估量表(TIME-H)评分、压疮愈合计分量表(PUSH)评分]。数据比较采用t检验和χ^(2)检验。结果(1)创面愈合情况:观察组创面愈合率为87.33%(131/150),对照组创面愈合率为77.33%(116/150),观察组创面愈合率明显大于对照组,差异有统计学意义(χ^(2)=5.625,P<0.05)。(2)SAS、SDS评分:治疗前观察组与对照组患者SAS评分[(66.25±7.14)、(65.63±6.26)分]、SDS评分[(68.56±8.03)、(69.10±7.85)分]比较差异均无统计学意义(t=0.735、0.589,P>0.05),治疗后2组SAS评分[(48.19±8.32)、(55.41±7.62)分]、SDS评分[(46.19±9.04)、(57.18±7.25)分]明显降低,且观察组小于对照组,差异均有统计学意义(t=7.838、11.615,P<0.05)。(3)平均住院时间和平均住院费用:观察组平均住院时间[(7.04±1.15)d]短于对照组[(9.62±1.42)d],观察组平均住院费用[(7426.45±278.19)元]少于对照组[(8215.73±317.46)元],差异均有统计学意义(t=17.792、153.201,P<0.05)。(4)WBS、BWAT、TIME-H、PUSH:治疗前观察组和对照组患者WBS[(11.77±2.12)、(12.04±2.03)分]、BWAT[(64.16±5.21)、(64.78±4.73)分]、TIME-H[(10.16±1.27)、(10.45±1.32)分]、PUSH[(15.19±2.10)、(14.98±2.45)分]差异均无统计学意义(t=1.127、1.079、1.939、0.797,P>0.05),治疗后2组BWAT[(49.21±4.86)、(57.15±7.30)分]、TIME-H[(4.27±1.66)、(7.46±1.80)分]、PUSH[(6.86±3.64)、(9.03±2.85)分]均降低,WBS[(18.10±1.41)、(15.81±1.36)分]升高,观察组治疗效果优于对照组,差异均有统计学意义(t=14.317、11.089、15.956、5.749,P<0.05)。结论MDT诊疗模式可明显促使患者创面恢复,改善患者焦虑抑郁状态,缩短住院时间,减少住院费用,使患者获得优质、全程、专业的治疗,具有一定的临床应用意义。

Objective To explore the application and research of multi-disciplinary team(MDT)in the treatment of chronic wounds in Qinghai area.Methods Three hundred patients with chronic wound treated in Qinghai Provincial People′s Hospital from June 2017 to June 2020 were randomly divided into observation group and control group according to random number table method,with 150 cases in each group.The observation group was given MDT mode treatment and nursing,and the control group was given ordinary treatment and nursing.The wound healing,the changes of psychological anxiety and depression[self rating anxiety scale(SAS),self rating depression scale(SDS)],length of stay and hospitalization expenses,wound assessment[wound bed score(WBS),Bate Jensen wound assessment system(BWAT),TIME-H,total subscale of pressure sore healing(PUSH)scores]of the two groups were observed before and after treatment.The data were compared by t-test and chi-square test.Results(1)Wound healing:the wound healing rate of the observation group was 87.33%(131/150),and that of the control group was 77.33%(116/150).The wound healing rate of the observation group was significantly higher than that of the control group,the difference was statistically significant(χ^(2)=5.625,P<0.05).(2)SAS,SDS scores:there were no statistically significant differences in SAS scores[(66.25±7.14),(65.63±6.26)points]and SDS scores[(68.56±8.03),(69.10±7.85)points]between the observation group and the control group before treatment(t=0.735,0.589;P>0.05).SAS scores[(48.19±8.32),(55.41±7.62)points]and SDS scores[(46.19±9.04),(57.18±7.25)points]decreased significantly after treatment,the observation group was smaller than the control group,and the differences were statistically significant(t=7.838,11.615;P<0.05).(3)Average hospitalization time and average hospitalization cost:the average hospitalization time of the observation group[(7.04±1.15)d]was shorter than that of the control group[(9.62±1.42)d],and the average hospitalization cost of the observation group[(7426.45±278.19)yuan]was less than that of the control group[(8215.73±317.46)yuan],the differences were statistically significant(t=17.792,153.201;P<0.05).(4)WBS,BWAT,TIME-H and PUSH:there were no statistically significant differences in WBS[(11.77±2.12),(12.04±2.03)points],BWAT[(64.16±5.21),(64.78±4.73)points],TIME-H[(10.16±1.27),(10.45±1.32)points],PUSH[(15.19±2.10),(14.98±2.45)points]between the observation group and the control group before treatment(t=1.127,1.079,1.939,0.797;P>0.05),and BWAT[(49.21±4.86),(57.15±7.30)points]after treatment TIME-H[(4.27±1.66),(7.46±1.80)points],PUSH[(6.86±3.64),(9.03±2.85)points]decreased and WBS[(18.10±1.41),(15.81±1.36)points]increased.The treatment effect of the observation group were better than those of the control group,and the differences were statistically significant(t=14.317,11.089,15.956,5.749;P<0.05).Conclusion MDT diagnosis and treatment mode can significantly promote the recovery of patients′wounds,improve patients′anxiety and depression,shorten hospital stay,reduce hospitalization expenses,and enable patients to obtain high-quality,whole process and professional treatment,which has certain clinical significance.