眩晕/头晕MDT诊疗模式初探  

A Preliminary Study on Multi-Disciplinary Team Model for Vertigo/Dizziness Management

作　　者：庞安然 毛忠瑶 黎颖强 邓东舟 陆翔 刘争[1] 冰丹[1] PANG Anran;MAO Zhongyao;LI Yinqiang;DENG Dongzhou;LU Xiang;LIU Zheng;BING Dan(Department of Otolaryngology Head and Neck Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院耳鼻喉头颈外科,武汉430030

出　　处：《中华耳科学杂志》2024年第6期890-894,共5页Chinese Journal of Otology

基　　金：国家重点研发项目(2023YFC2508400);湖北省重点研发计划(2022BCA006);武汉市知识创新专项(2022022101015011)。

摘　　要：目的探究多学科团队(multi-disciplinary team,MDT)诊疗模式对眩晕/头晕疾病诊疗质量、患者身心康复以及社会效益的影响,为国内眩晕/头晕MDT的建设、尤其是由耳鼻喉科牵头组建眩晕/头晕MDT团队提供参考。方法回顾性分析2020年10月至2022年7月华中科技大学同济医学院附属同济医院耳鼻喉头颈外科收治的眩晕/头晕MDT患者的病历资料,并于诊后128.40±87.01 d采用电话问卷的方式进行随访。采用卡方检验和单因素方差分析对结果进行评估分析。结果175例就诊患者82.86%(145例)接受了随访,对145例患者进一步统计分析显示:男性62例(42.76%)平均年龄46.03±17.42岁,女性83例(57.24%)平均年龄51.54±16.81岁;湖北省内患者121例(83.45%),就诊占比与空间距离相关;就诊前,有59例患者(40.69%)受眩晕困扰达数年之久,花费超过1万元的患者有44例(30.34%),就诊后,患者对眩晕/头晕MDT专家团队专业度、服务满意度高达97.93%,且有93.10%的患者认为解决了他们的眩晕/头晕所带来的困扰;功能性头晕(80例,55.17%)和前庭性偏头痛(vestibular migraine,VM)/可能的VM(37例,25.52%)为占比最高的两种疾病;随访时发现仍有39例未能严格遵从医嘱,这部分患者中眩晕改善情况欠佳,其中仅16.65%改善超过一半以上者,远低于医嘱落实者(71.7%)。结论眩晕/头晕病因复杂,建立一种具有人文关怀的全方位、多维度的MDT模式,可提升诊疗质量,减少患者医疗支出,增强社会效益的同时也能有效推进眩晕学科建设。Objective To report the impact of the multi-disciplinary team(MDT)management model on treatment,physical and psychological rehabilitation and management of patients with vertigo/dizziness and potential social benefits,to promote its development and adoption in China.Methods Medical records of 175 patients with vertigo/dizziness managed by the MDT model from October 2020 to July 2022 in our hospital were retrospectively identified and followed up by a telephone questionnaire 128.40±87.01 days after their visits.Chi-square test and oneway ANOVA were used to analyze data,including demographics,clinical presentation,treatments before MDT visit,patient expenses,post-MDT improvement,and patient satisfaction.Results Of the 145 patients accepting the telephone follow-up,62(42.76%)were men aged 46.03±17.42 years and 83(57.24%)were women aged 51.54±16.81 years.Prior to MDT,59 patients(40.69%)had been suffering from vertigo for several years,and 44 patients(30.34%)had spent more than 10,000 yuan.Most patients(97.93%)were satisfied with the professionalism and service provided by MDT and report resolution of troubles caused by vertigo/dizziness(93.10%).Functional dizziness(80 cases,55.17%)and VM/possible VM(37 cases,25.52%)were the most common diseases in this group.The follow-up showed that 39 patients failed to follow the medical advice,with less than ideal improvement(only 16.65%of these patients achieved improvement by more than 50%,compared to 71.7%in those sticking to the medical advice).Conclusion The etiology of vertigo/dizziness is complex and requires multidisciplinary interventions.Establishing an all-round and multidimensional MDT approach with humanistic care can improve treatment outcomes,reduce patient medical expenses and enhance social benefits while also effectively promoting development of the dizziness field.

关 键 词：眩晕/头晕 眩晕/头晕MDT 诊疗质量 

分 类 号：R441.2[医药卫生—诊断学]