多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察  

Clinical efficacy observation of treating elderly patients with acute non-variceal upper gastrointestinal hemorrhage using the MDT model

作　　者：姜里蛟 张峰[2] 周玉萍 Lijiao Jiang;Feng Zhang;Yuping Zhou(Seventh Department of Health Care,Second Medical Center,PLA General Hospital,Beijing 100039,China;Department of Geriatrics,Seventh Medical Center,PLA General Hospital,Beijing 100010,China)

机构地区：[1]解放军总医院第二医学中心保健七科,北京100039 [2]解放军总医院第七医学中心老年病科,北京100010

出　　处：《中华消化病与影像杂志（电子版）》2023年第6期520-524,共5页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的综合评估多学科诊疗模式(MDT)在治疗老年急性非静脉曲张性上消化道大出血患者中的实施效果,在不同救治模式下的成本效益分析和护理质量。方法回顾性分析2021年1月至2023年1月于解放军总医院第二医学中心就诊的114例老年急性非静脉曲张性上消化道大出血患者,其中15例不符合纳入标准,4例不愿参与研究,3例资料不全,最终纳入92例患者作为研究对象。根据不同的急诊救治方式,将所有患者分为对照组(常规急诊救治)52例和观察组(MDT救治)40例。观察比较两组患者的临床疗效、手术相关指标(出血停止时间、等待时间、术中出血量、住院时间、住院费用)、死亡率及再出血率、不良反应发生率以及护理满意度。结果观察组的治疗总有效率为97.50%,显著高于对照组的75.00%(P<0.05)。与对照组相比,观察组的出血停止时间、等待时间以及住院时间均显著缩短,术中出血量和住院费用也显著减少(P<0.05);观察组的死亡率、再出血率、不良反应发生率均显著低于对照组(P<0.05);护理满意度显著优于对照组(P<0.05)。结论MDT模式在老年急性非静脉曲张性上消化道大出血患者的救治中具有明显优势,治疗效果、成本效益和护理满意度高。Objective To comprehensively evaluate the effectiveness of the multidisciplinary team(MDT)approach in the treatment of elderly patients with acute non-variceal upper gastrointestinal bleeding,cost-benefit analysis and nursing quality under different treatment modalities.Methods A total of 114 elderly patients with acute non-variceal upper gastrointestinal bleeding in the Second Medical Center of the PLA General Hospital from January 2021 to January 2023 were retrospectively analyzed.Among them,15 did not meet the inclusion criteria,4 were unwilling to participate in the study,and 3 had incomplete data.Finally,92 elderly patients with acute upper gastrointestinal bleeding were included as the study subjects.Based on different emergency treatment methods,all patients were divided into a control group(conventional emergency treatment,n=52)and an observation group(MDT model treatment,n=40).The clinical efficacy,surgical-related indicators(bleeding cessation time,waiting time,intraoperative blood loss,length of hospital stay,hospitalization costs),mortality and rebleeding rate,adverse reactions,and nursing satisfaction were compared between the two groups.Results The overall effective rate of treatment in the observation group was 97.50%,significantly higher than the 75.00%in the control group(P<0.05).Compared with the control group,the observation group had significantly shorter times to stop bleeding,waiting times,and lengths of hospital stay,and it also had significantly reduced intraoperative blood loss and hospitalization costs(P<0.05).Additionally,the observation group exhibited significantly lower rates of mortality,rebleeding,and adverse reactions(P<0.05),and nursing satisfaction was significantly higher than that in the control group(P<0.05).Conclusion The MDT model has a distinct advantage in treating elderly patients with acute non-variceal upper gastrointestinal bleeding,with high therapeutic effect,cost effectiveness and nursing satisfaction.

关 键 词：多学科诊疗模式 急性非静脉曲张性上消化道出血 老年人 临床疗效 不良反应 护理满意度 

分 类 号：R473.5[医药卫生—护理学]