多学科团队诊疗模式下PDCA循环管理对胰腺癌患者围术期营养状态的影响

Effects of PDCA cycle management on perioperative nutritional status of patients with pancreatic cancer under multidisciplinary team diagnosis and treatment mode

目的分析多学科团队诊疗模式下开展计划-实施-检查-处理(PDCA)循环管理对胰腺癌患者围术期营养状态的影响。方法选取2019年7月至2020年11月在上海长征医院接受诊疗的132例胰腺癌手术患者,根据随机数字表法将其分为两组,对照组66例围术期予以常规护理,观察组66例围术期于多学科团队诊疗模式下开展PDCA循环管理,对比两组心理应激水平、营养状态及康复指标。结果观察组出院时抑郁-焦虑-应激自评量表简版(DASS-21)中各分量表评分均比对照组低,差异有统计学意义(P<0.05);术后7 d、出院日,观察组营养不良-炎症评分(MIS)、主观综合性营养表(SGA)评分均比对照组相同时间点低,同时观察组血清白蛋白(ALB)、总蛋白(TP)、转铁蛋白(SF)、前白蛋白(PA)水平及体重指数(BMI)均比对照组相同时间点高,差异有统计学意义(P<0.05);观察组术后首次排气、首次排便、下床活动、经口进食及住院时间均比对照组短,差异有统计学意义(P<0.05)。结论多学科团队诊疗模式下开展PDCA循环管理在胰腺癌患者中的效果显著,有助于改善其心理应激水平及营养状态,并促进患者术后康复。

Objective To analyze the effects of plan-do-check-action(PDCA)cycle management on perioperative nutritional status of patients with pancreatic cancer under multidisciplinary team diagnosis and treatment mode.Methods A total of 132 patients undergoing surgery for pancreatic cancer from July 2019 to November 2020 were selected and divided into two groups based on random number table.A total of 66 patients in the control group received routine nursing during perioperative period,and 66 patients in the observation group received PDCA cycle management under the multidisciplinary team diagnosis and treatment mode.Psychological stress level,nutritional status and rehabilitation index were compared between the two groups.Results The scores of self-rating scale for depression,anxiety and stress(DASS-21)in the observation group at discharge were lower than those in the control group,and the difference was statistically significant(P<0.05).Seven days after surgery and discharge day,the malnutrition inflammation score(MIS)of malnutrition and subjective global assessment(SGA)in the observation group were lower than that in the control group at the same time point,meanwhile,serum albumin(ALB),total protein(TP),transferrtin(SF),the levels of prealbumin(PA)and body mass index(BMI)were higher than those of control group at the same time point,and the differences were statistically significant(P<0.05).The first postoperative exhaust,first defecation,movement out of bed,oral feeding and hospitalization time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).Conclusions PDCA cycle management under the multidisciplinary team diagnosis and treatment mode has a significant effect on patients with pancreatic cancer,which can improve their psychological stress level and nutritional status,and promote postoperative recovery of patients.