多学科协作治疗濒临截肢伤的临床应用研究  

Clinical application of multidisciplinary team in the treatment of amputated wounds

作　　者：宋渊[1] 赵继荣[1] 李树君[1] 杜自忠[1] 蒋振兴[1] 李岩[1] 张海清[1] 赵宁[1] 慕向前 程如意[1] 赵生鑫 Song Yuan;Zhao Jirong;Li Shujun;Du Zizhong;Jiang Zhenxing;Li Yah;Zhang Haiqing;Zhao Ning;Mu Xiangqian;Cheng Ruyi;Zhao Shengxin(Department of Hand Surgeu, Gansu Provincial Hospital of TCM, Lanzhou 730050, China;Gansu University of Chinese Medicine, Lanzhou 730020, China)

机构地区：[1]甘肃省中医院手外科,兰州730050 [2]甘肃中医药大学,兰州730020

出　　处：《中华损伤与修复杂志（电子版）》2018年第2期107-111,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：甘肃省中医药管理局科研课题(GZK-2016-73)

摘　　要：目的探讨多学科协作(MDT)治疗下肢濒临截肢伤的临床疗效,分析MDT在濒临截肢伤治疗中的应用价值。方法本研究通过对前期治疗的86例濒临截肢伤患者的资料做为对照组进行回顾性分析,与2016年1月至2017年6月甘肃省中医院采用中西医MDT治疗的60例患者(试验组)进行对比分析,观察统计治疗后两组手术次数、住院时间、住院费用、保肢率;随访试验组术后6个月患者远期生活质量评估(KPS)及临床疗效评价。两组间手术次数、住院时间及住院费用显著性差异比较采用t检验,保肢成功率比较采用χ~2检验。结果试验组保肢成功46例,成功率为76.7%,对照组保肢成功51例,成功率为59.3%,差异有统计学意义(χ~2=4.779,P=0.029);其中试验组手术次数(2.47±0.98)次、住院时间(67.71±24.50)d分别比对照组[(2.98±1.05)次、(72.71±19.38)d]少,差异均有统计学意义(t=-2.426、-2.237,P=0.017、0.029),住院总费用分别为(9.20±4.16)、(10.43±3.46)万元,两组比较差异无统计学意义(t=-1.577,P=0.118)。试验组末次术后随访6个月,KPS为(62.39±11.77)分,临床总优良率为78.26%。结论 MDT在濒临截肢伤的救治中可明显降低手术次数及住院时间,且患者远期生活质量高,具有较好的临床疗效,但患者住院费用无明显缩减。Objective To explore the clinical efficacy of multidisciplinary team（ MDT） in the treatment of lower extremity threatened amputation,and to analyze the value of MDT in the treatment of lower extremity threatened amputation. Methods In this study,86 patients who were at risk of amputation were retrospectively analyzed as control group. From January 2016 to June 2017,60 patients（ experimental group） who were treated with multi-disciplinary cooperation of traditional Chinese and western medicine in Gansu Provincial Hospital of TCM were compared and analyzed. The operation times,hospitalization time,hospitalization cost and limb salvage rate of the two groups were statistically analyzed. The long-term quality of life of patients in the trial group was evaluated by karnofsky performance scale（ KPS） and the total clinical effective rate. T test was used to compare the number of operations,hospitalization time and hospitalization cost between the two groups,the success rate of limb salvage was compared with the χ^2 test. Results Fortysix cases of limb salvage were successful in the experimental group,the success rate was 76. 7%,while fiftyone cases in the control group,whose limb salvage success rate was 59. 3%,the difference was statistically significant（ χ^2= 4. 779,P = 0. 029）. There were（ 2. 47 ± 0. 98） times of operation and（ 67. 71 ±24. 50） days of hospitalization in the experimental group,which were less than that in the control group,（ 2. 98 ± 1. 05） times and（ 72. 71 ± 19. 38） days,and the differences were statistically significant（ t =-2. 426,-2. 237,P = 0. 017,0. 029）. The total hospitalization expenses of the experimental group and control group were（ 9. 20 ± 4. 16）,（ 10. 43 ± 3. 46） million yuan respectively,there was no significant difference between the two groups（ t =-1. 577,P = 0. 118）. The KPS score was 62. 39 ± 11. 77 in the last6 months after operation in the experimental group,and the total clinical excellent and good rate was78. 26%. Conclusi

关 键 词：截肢 创伤性 多学科协作 治疗结果 临床研究 

分 类 号：R658[医药卫生—外科学]