远程多学科团队协作会诊对提高产前诊断服务能力的探索  

Exploration of multi-disciplinary team remote consultation in improving prenatal diagnosis service

作　　者：杲丽[1] 王姗 张艳[1] 赵欣荣[1] 吴怡[1] 华人意 孙金铃 王彦林[1] GAO Li;WANG Shan;ZHANG Yan;ZHAO Xinrong;WU Yi;HUA Renyi;SUN Jinling;WANG Yanlin(Shanghai Key Laboratory of Embryo Original Diseases,Prenatal Diagnostic Center,The International Peace Maternal and Child Health Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院,上海市胚胎源性疾病重点实验室,上海200030

出　　处：《上海医学》2023年第1期13-16,共4页Shanghai Medical Journal

基　　金：国家自然科学基金(81971401);上海申康医院发展中心临床科技创新项目(SHDC12019634);上海交通大学“医工交叉研究基金”(YG2017MS37)。

摘　　要：目的 探讨远程MDT会诊对提高产前诊断服务能力的帮助。方法 选择上海交通大学医学院附属国际和平妇幼保健院产前诊断中心2019年1月—2020年5月接受MDT诊疗的孕妇2 918例,其中传统现场MDT 2 766例,远程MDT 152例。比较传统现场MDT组与远程MDT组孕妇的会诊原因、会诊失约率、会诊咨询时间、介入性产前诊断接受率、后续随访应答率,以及不同胎儿疾病的继续妊娠率,评估不同形式MDT的产前诊断服务能力。结果 传统现场MDT组因超声软指标、胎儿心脏循环系统异常接受会诊的孕妇占比显著高于远程MDT组(P<0.001);而胎儿因泌尿系统和颜面部异常接受会诊的孕妇占比则显著低于远程MDT组(P值均<0.001)。远程MDT组孕妇的会诊失约率为1.9%,显著低于传统现场MDT组的13.6%(P<0.01)。远程MDT组孕妇的咨询时间显著长于传统现场MDT组[(21.6±3.5) min比(10.3±2.4) min,P<0.01]。远程MDT组孕妇的介入性产前诊断接受率显著高于传统现场MDT组(32.2%比24.8%,P<0.05)。远程MDT组胎儿颜面部异常的继续妊娠率及诊断符合率均显著高于传统现场MDT组(58.3%比31.1%,91.7%比68.9%,P值均<0.05)。结论 远程MDT更具针对性,也更有说服力,且不受地域、时间的限制。在胎儿颜面部发育异常的多学科咨询中,远程MDT更有优势,可提供精准化的产前诊断。Objective To explore the role of multi-disciplinary team(MDT) remote consultation in prenatal diagnosis. Methods A total of 2 918 pregnant women who received prenatal MDT(2 766 on-site MDT and 152 remote MDT) consultation in the Prenatal Diagnosis Center of International Peace Maternity and Child Health Hospital from January 2019 to May 2020 were enrolled in this study. The reasons of consultation, non-attendance rate, consultation time, acceptance rate of interventional prenatal diagnosis, follow-up response rate, and on-going pregnancy proportion of different fetal diseases were compared between on-site MDT group and remote MDT group. The capacity of prenatal diagnosis was assessed. Results The proportion of consultation due to ultrasound soft indicators and abnormal fetal cardiac circulatory system in traditional MDT group was significantly higher than that in the remote MDT group(P<0.001). The proportion of consultation due to urinary and fetal facial dysplasia in traditional MDT group was significantly lower than that in the remote MDT group(P<0.001). The non-attendance rate of remote MDT was significantly lower than that of on-site MDT(1.9% vs. 13.6%, P<0.01). The consultation time of each pregnant woman was significantly longer in remote MDT than that in on-site MDT([21.6±3.5] min vs. [10.3±2.4] min, P<0.01). The acceptance rate of interventional prenatal diagnosis in remote MDT group was significantly higher than that in on-site MDT group(32.2% vs. 24.8%, P<0.05). The on-going pregnancy proportion and diagnostic accordance rate of facial abnormalities of remote MDT group were significantly higher than those of on-site MDT group(58.3% vs. 31.1%, 91.7% vs. 68.9%, both P<0.05). Conclusion Prenatal remote MDT consultation is more targeted, persuasive, and convenient. Remote MDT consultation for fetal facial dysplasia has more advantages and can provide accurate prenatal diagnosis.

关 键 词：远程会诊 多学科团队协作 产前诊断 

分 类 号：R715.5[医药卫生—妇产科学]