新生儿颅脑损伤多学科协作诊疗管理体系的实践应用效果

Application effect of the multidisciplinary collaborative diagnosis and treatment management system for the neonatal brain injury

目的:观察新生儿颅脑损伤(NBI)多学科协作诊疗(MDT)管理体系的应用效果。方法:本院从2022年1月开始应用NBI MDT管理体系,应用前(2021年1-12月)159例为对照组,应用后(2022年1-12月)228例为观察组,比较两组治疗前与治疗3个月后新生儿神经行为量表(NBNA)评分、贝利婴儿发展量表(BSID)评分、症状缓解时间、住院时间、并发症及临床疗效。结果:治疗后观察组总有效率(95.6%)高于对照组(89.9%),NBNA原始反射(5.16±0.68分)、一般反应(5.02±0.63分)、主动肌张力(6.83±0.92分)、行为能力(10.12±1.76分)及被动肌张力(6.95±0.94分)评分均高于对照组(4.29±0.75分、4.48±0.71分、5.14±0.83分、8.65±1.32分、5.23±0.87分),BSID运动发育指数(104.17±10.75分)、智力发育指数(96.12±9.85分)评分均高于对照组(91.32±10.06分、84.35±8.62分),头皮血肿(5.73±1.02d)、面色苍白(5.90±1.13d)、囟门张力高缓解时间(4.85±0.84d)及住院时间(11.05±2.73d)均短于对照组(6.12±1.05d、6.34±1.08d、5.72±1.26d、12.96±3.14d),并发症总发生率(4.8%)低于对照组(18.9%)(均P<0.05)。结论:NBI MDT管理体系应用可促进患儿症状缓解,缩短住院时间,降低并发症风险,提高临床疗效。

Objective:To observe the practical effect of the multidisciplinary collaborative diagnosis and treatment management system for the neonatal brain injury(NBI).Methods:The hospital started to use the multidisciplinary collaborative diagnosis and treatment(MDT)management system for NBI from January 2022.159 neonates without MDT who had admitted to the hospital from January to December 2021 were included in control group,and 228 neonates with MDT who had admitted to the hospital from January to December 2022 were included in observation group.The scores of Neonatal Behavioral Neurological Assessment(NBNA)and the Bayley Scales of Infant and Toddler Development(BSID),the time to symptom relief,the duration of hospital stay,the complications rate and the clinical efficacy of the neonates before and after treatment were compared between the two groups.Results:After treatment,the total effective rate(95.6%)of the neonates in the observation group was significantly higher than that(89.9%)of the neonates in the control group.The scores of NBNA primitive reflex(5.16±0.68 points),the general reaction(5.02±0.63 points),the active muscle tension(6.83±0.92 points),the behavioral ability(10.12±1.76 points),the passive muscle tension(6.95±0.94 points),the BSID motor development index(104.17±10.75 points)and the mental development index(96.12±9.85 points)of the neonates in the observation group were significantly higher than those(4.29±0.75 points,4.48±0.71 points,5.14±0.83 points,8.65±1.32 points,5.23±0.87 points,91.32±10.06 points and 84.35±8.62 points)of the neonates in the control group.The relief time of scalp hematoma(5.73±1.02d),pale face(5.90±1.13d)and tension of fontanelle(4.85±0.84d),and the hospitalization time(11.05±2.73d)of the neonates in the observation group were significantly shorter than those(6.12±1.05d,6.34±1.08d,5.72±1.26d,and 12.96±3.14d)of the neonates in the control group.The total incidence of complications(4.8%)of the neonates in the observation group was significantly lower than that(18.9%)of the neonates in the control group(all P<0.05).Conclusion:The MDT management system for NBI of the neonates can promote their symptom relief,shorten their hospital stay,reduce their risk of complications,and improve their clinical efficacy.