脑损伤患儿的多学科协作诊疗模式效果评估  

Effect Evaluation of Multidisciplinary Collaborative Diagnosis and Treatment Model for Children with Brain Injury

作　　者：余雄武 周芸丽 丁志勇 王朝红 谢泽翌 陆宏娜 金华 YU Xiongwu;ZHOU Yuni;DING Zhiyong;WANG Chaohong;XIE Zeyi;LU Hongna;JIN Hua(Dept.of Pediatrics,Qujing Maternal and Child-care Hospital,Qujing Yunnan 655002,China)

机构地区：[1]曲靖市妇幼保健院儿科,云南曲靖655000

出　　处：《昆明医科大学学报》2024年第1期156-162,共7页Journal of Kunming Medical University

基　　金：昆明理工大学-曲靖市妇幼保健院医学联合专项基金资助项目(KUST-QJFY2022001);云南省神经系统疾病临床医学中心基金资助项目(zx2019030501)。

摘　　要：目的 总结曲靖市妇幼保健院儿科对脑损伤患儿实施多学科协作诊疗模式(multi-disciplinary team,MDT)的诊疗经验,评估多学科诊疗模式对新生儿脑损伤的诊疗效果。方法 收集2019年11月至2023年4月在曲靖市妇幼保健院儿科诊治的脑损伤患儿的临床资料,将2019年10月至2020年6月收治的脑损伤患儿485例作为非MDT组,2020年7月至2023年4月收治的脑损伤患儿405例作为MDT组,采用统计学方法对2组患儿的临床资料进行对比分析。结果 890例脑损伤患儿中有男519例,女371例。2组患儿年龄中位数及四分位数分别为MDT组2.00(0.82,5.00)岁,非MDT组1.00(1.00,4.00)岁。2组患儿脑损伤类型均以颅脑损伤为主,且在颅脑损伤及颅内出血患儿中,MDT组的治愈率均高于非MDT组,差异均有统计学意义(P<0.05)。MDT组的405例患儿中有154(38.0%)例行手术治疗,非MDT组的485例患儿中有121(24.9%)例行手术治疗,差异有统计学意义(P <0.05)。MDT组23.2%的患儿在住院期间出现危重情况,显著低于非MDT组的30.5%,差异均具有统计学意义(P <0.05);MDT组的未愈率(2.0%)也显著低于非MDT组(5.6%),且MDT组的治愈率(40.5%)显著高于非MDT组(34.4%),差异均有统计学意义(P <0.05);MDT组患儿的治疗费、药品费、卫生材料费均低于非MDT组,差异均具有统计学意义(P <0.05)。脑损伤患儿治愈率的多因素Logistic回归模型分析结果显示,利用MDT模式诊治脑损伤能有效提高脑损伤患儿的治愈率(RR=1.513,95%CI=1.134~2.020)。实际住院天数的多重线性回归模型分析结果显示:MDT对患儿的实际住院天数的影响无统计学意义(P> 0.05)。结论 利用MDT模式诊治脑损伤患儿有利于提高治愈率,降低患儿疾病加重的风险,使脑损伤患儿获得明显疗效,MDT模式值得在脑损伤患儿中推广应用。Objective To summarize the experience of multi-disciplinary team(MDT)in the pediatric department of Qujing Maternal and Child Health Hospital,and to evaluate the effectiveness of MDT on neonatal brain injury.Methods The clinical data of children with brain injury and treated in the pediatrics department of Qujing Maternal and Child Health Hospital from November 2019 to April 2023 were collected.The children with brain injury and treated from October 2019 to June 2020 were regarded as the non-MDT group,and the children with brain injury and treated from July 2020 to April 2023 were regarded as the MDT group for comparative analysis.Chi-square test/t-test was used to compare and analyze the clinical data of the two groups.Results Among the 890 cases of pediatric brain injury,there were 519 males and 371 females.The median and quartiles of the age distribution for the two groups were as follows:MDT group 2.00(0.82,5.00)years and non-MDT group 1.00(1.00,4.00)years.Craniocerebral injury was the main type of brain injury in both groups,in addition,among children with craniocerebral injury and intracranial hemorrhage,the cure rate of MDT group was higher than that of non-MDT group,and the difference was statistically significant(P<0.05).Among the 405 children in MDT group,154(38.0%)underwent the surgery,while among the 485 children in non-MDT group,121(24.9%)underwent the surgery.The difference was statistically significant(P<0.05).23.2%of children in MDT group were in critical condition during the hospitalization,which was significantly lower than that in non-MDT group(30.5%),and the difference was statistically significant(P<0.05).The unhealed rate of MDT group(2.0%)was also significantly lower than that of non-MDT group(5.6%),the cure rate of MDT group(40.5%)was significantly higher than that of non-MDT group(34.4%),and there was a statistically significant difference(P<0.05).The expense of treatment,medicine and sanitary materials in MDT group were lower than those in non-MDT group,and the differences were statistic

关 键 词：多学科协作 脑损伤患儿 诊疗效果 

分 类 号：R714.21[医药卫生—妇产科学]