多学科协作模式在糖尿病伴下肢创伤后慢性溃疡围术期护理中的效果  

Effect of multidisciplinary cooperation model on perioperative nursing of chronic ulcer of diabetes mellitus patients following lower extremity trauma

作　　者：顾磊磊[1] 潘红英[1] 范顺武[1] Gu Leilei;Pan Hongying;Fan Shunwu(Department of Orthopedics , Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,杭州310016

出　　处：《中华创伤杂志》2021年第8期744-749,共6页Chinese Journal of Trauma

基　　金：浙江省教育厅一般科研项目(Y201839093)。

摘　　要：目的:探讨多学科协作(MDT)模式在糖尿病伴下肢创伤后慢性溃疡围术期护理的效果。方法:采用回顾性病例对照研究分析2015年1月至2019年12月浙江大学医学院附属邵逸夫医院收治的122例糖尿病伴下肢创伤后慢性溃疡患者临床资料,其中男58例,女64例;年龄40~76岁[(56.0 ± 4.7)岁]。创面部位:足跟部10例,外踝部12例,足趾22例,小腿59例,大腿19例。60例患者接受MDT模式护理(协作护理组),62例患者接受传统护理(传统护理组)。比较两组术后1,3 d及出院当天视觉模拟评分(VAS)及空腹血糖、护理后的心理状态评分[焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分]、术后2周及1个月创面面积及深度、术后1个月内空腹血糖、术后1个月再次入院时截肢率、再次清创发生率及直接缝合率。结果:患者均获随访0.5~3个月[(1.2 ± 0.7)个月]。协作护理组术后1 d、3 d、出院当天观察组VAS分别为1.0(1.0,2.0)分、1.0(0.0,1.0)分、1.0(0.0,1.0)分,低于传统护理组的2.0(2.0,2.3)分、2.0(2.0,2.0)分、1.0(1.0,2.0)分( P < 0.05)。协作护理组术后1 d、3 d、出院当天空腹血糖为(7.2 ± 0.8)mmol/L、(6.9 ± 0.8)mmol/L、(6.9 ± 0.7)mmol/L,低于传统护理组的(7.8 ± 0.8)mmol/L、(7.8 ± 0.8)mmol/L、(7.7 ± 0.9)mmol/L( P < 0.05)。协作护理组护理后SAS评分和SDS评分分别为(8.4 ± 0.8)分和(11.2 ± 1.0)分,传统护理组为(8.7 ± 0.7)分和(12.3 ± 1.0)分( P < 0.05)。协作护理组术后2周创面面积及深度为(29.4 ± 3.9)cm 2、(1.4 ± 0.4)cm,低于传统护理组的(33.3 ± 3.6)cm 2、(1.5 ± 0.5)cm( P < 0.05);术后1个月创面面积、深度为(24.5 ± 3.8)cm 2、(0.9 ± 0.4)cm,低于传统护理组的(30.6 ± 4.8)cm 2、(1.2 ± 0.5)cm( P < 0.05)。协作护理组术后1个月内空腹血糖均明显低于传统护理组( P < 0.05)。所有患者术后1个月再次入院时,协作护理组截肢率为5%(3/60),需要再次清创发生率为7%(4/60),明显低于传统护理组的18%(11/62)�Objective:To explore the effect of multidisciplinary collaboration(MDT)mode on perioperative nursing of chronic ulcer of diabetes mellitus patients following lower extremity trauma.Methods:A retrospective case-control study was conducted to analyze the clinical data of 122 diabetes mellitus patients combined with chronic ulcer following lower extremity trauma admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2015 to December 2019. There were 58 males and 64 females at age of 40-76 years[(56.0 ± 4.7)years]. The wounds were located at the heel in 10 patients,at the lateral ankle in 12,at the toe in 22,at the calf in 59 and at the thigh in 19. Sixty patients received MDT care(collaborative care group),and 62 patients received traditional care(traditional care group). Visual analogue scale(VAS)and level of fasting plasma glucose were measured at days 1 and 3 postoperatively and on the day of discharge. Mental status of the patients was evaluated using self-evaluation of anxiety scale(SAS)and self-rating depression scale(SDS)after nursing. Area and depth of wounds was detected at postoperative 2 weeks and 1 month,and level of fasting glucose was measured again within 1 month after operation. The rate of amputation,incidence of debridement and direct suture rate were documented while hospitalized again at postoperative 1 month.Results:All patients were followed up for 0.5-3 months[(1.2 ± 0.7)months]. VAS was 1.0(1.0,2.0)points,1.0(0.0,1.0)points and 1.0(0.0,1.0)points in collaborative care group at days 1 and 3 postoperatively and on the day of discharge,compared to 2.0(2.0,2.3)points,2.0(2.0,2.0)points and 1.0(1.0,2.0)points in traditional care group( P < 0.05). Level of fasting blood glucose was(7.2 ± 0.8)mmol/L,(6.9 ± 0.8)mmol/L and(6.9 ± 0.7)mmol/L in collaborative care group on days 1 and 3 postoperatively and on the day of discharge,compared to(7.8 ± 0.8)mmol/L,(7.8 ± 0.8)mmol/L and(7.7 ± 0.9)mmol/L in traditional care group( P < 0.05). Scores of SAS a

关 键 词：下肢 护理过程 糖尿病 多学科协作模式 

分 类 号：R473.6[医药卫生—护理学]