基于FTS理念的多学科团队管理模式对动脉瘤性下腔出血患者病情、神经功能及预后的影响

The impact of multidisciplinary team management model based on FTS concept on the condition,neurological function and prognosis of patients with aneurysmal inferior cavity hemorrhage

目的探讨基于快速康复外科(fast track surgery,FTS)理念的多学科团队管理模式在动脉瘤性下腔出血患者中应用价值。方法收集我院113例动脉瘤性下腔出血患者临床资料进行回顾性分析,开展病例对照研究,根据护理方案分为对照组(n=56)和研究组(n=57)。2组均行弹簧圈栓塞术,对照组予以传统护理,在传统护理基础上,研究组予以基于FTS理念的多学科团队管理模式。统计两组并发症、术中血压及心率波动值、病情恢复情况[住院时间、排便时间、肠鸣音恢复时间、出院时格拉斯哥预后(glasgow outcome scale,GOS)评分]、护理满意度,对比入院时、出院时美国国立卫生院卒中量表(the National Institutes of Health Stroke Scale,NIHSS)、日常生活活动能力(activity of daily living,ADL)、生活质量综合评定问卷(generic quality of life inventory-74,GQOLI-74)。结果研究组术中血压及心率波动较对照组低(P<0.05);研究组住院时间、排便时间、肠鸣音恢复时间、肛门排气时间均短于对照组,出院时GOS评分较对照组高(P<0.05);出院时研究组NIHSS、ADL评分较对照组低(P<0.05);出院1个月时研究组心理功能、躯体功能、社会功能评分较对照组高(P<0.05);研究组并发症发生率3.51%较对照组15.79%低,护理满意度92.98%较对照组80.36%高(P<0.05)。结论基于FTS理念的多学科团队管理模式可减少动脉瘤性下腔出血患者术中血压及心率波动,促进其病情恢复,提高患者神经功能、日常生活能力及生活质量,降低并发症发生率,改善疾病预后。

Objective To explore the application value of a multidisciplinary team management model based on the concept of fast track surgery(FTS)in patients with aneurysmal inferior cavity hemorrhage.Methods The clinical data of 113 patients with aneurysmal inferior cavity hemorrhage in our hospital were collected for retrospective analysis and case-control study was carried out.According to nursing plans,they were divided into control group(n=56)and research group(n=57).Both groups underwent coil embolization,the control group received traditional nursing,and on the basis of traditional nursing,the research group received a multidisciplinary team management model based on the FTS concept.The complications,intraoperative blood pressure and heart rate fluctuations,recovery of illness[length of hospitalization,defecation time,recovery time of bowel sounds,glasgow outcome scale(GOS)score at discharge],and nursing satisfaction degree were calculated in the two groups.The National Institutes of Health Stroke Scale(NIHSS),activity of daily living(ADL),and generic quality of life inventory-74(GQOLI-74)at admission and discharge were compared.Results The intraoperative blood pressure and heart rate fluctuations in the research group were lower than those in the control group(P<0.05).In the research group,the length of hospitalization,defecation time,recovery time of bowel sounds,and anal exhaust time were shorter than those of the control group,while the GOS score at discharge was higher than that of the control group(P<0.05).The NIHSS and ADL scores of the research group were lower than those of the control group at discharge(P<0.05).The scores of mental function,physical function and social function of the research group were higher than those of the control group at 1 month after discharge(P<0.05).The complication rate of the research group was 3.51%,which was lower than that(15.79%)in the control group,and the degree of nursing satisfaction was 92.98%,which was higher than that(80.36%)of the control group(P<0.05).Conclusion The multidisciplinary team management model based on the FTS concept can reduce intraoperative blood pressure and heart rate fluctuations in patients with aneurysmal inferior cavity hemorrhage,promote their recovery,which can improve patients′neurological function,ADL and quality of life,reduce the incidence of complications,and improve the prognosis of the disease.