高龄骨科患者围手术期MDT全程管理模式探讨

王林夏; 彭棉棉; 金熙熙; 朱思品

doi:10.16766/j.cnki.issn.1674-4152.002333

高龄骨科患者围手术期MDT全程管理模式探讨

doi: 10.16766/j.cnki.issn.1674-4152.002333

1.
温州医科大学附属第二医院育英儿童医院疼痛科，浙江温州 325000
2.
温州医科大学附属第二医院育英儿童医院关节外科，浙江温州 325000
3.
温州医科大学附属第二医院育英儿童医院脊柱外科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2021KY212

详细信息

通讯作者:
王林夏, E-mail: tougao666999@163.com

中图分类号: R473 R68
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出版历程
- 收稿日期: 2021-08-09
- 网络出版日期: 2022-03-04

Whole process management by MDT mode in elderly orthopaedic patients during the peri-operative period

1.
Department of Pain, Yuying Children's Hospital, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨多学科协作(MDT)全程管理模式在高龄骨科患者围手术期中的应用效果。方法按入院时间先后顺序，将2019年3—9月温州医科大学附属第二医院育英儿童医院骨科收治的、围手术期采用传统管理模式的139例高龄手术患者作为常规组；将2019年10月—2020年4月骨科收治的143例高龄手术患者作为干预组，采用术前多学科团队评估→术中管理→术后快速康复→出院随访的MDT全程管理模式，对高龄骨科患者围手术期实施干预管理。比较2组高龄骨科患者术前等待时间及住院时间；对2组患者围手术期关节功能障碍、压力性损伤、肺部感染、下肢深静脉血栓形成等并发症的发生率进行对比分析。结果干预组高龄骨科患者术前等待时间2(2, 4)d短于常规组6(3, 7)d；住院时间10(6, 14)d短于常规组14(10, 17)d，差异有统计学意义(均P＜0.05)。干预组围手术期并发症的发生率(1.40%)显著低于常规组(10.07%，P＜0.05)。结论 MDT全程管理模式应用于高龄骨科患者围手术期，能够有效缩短高龄骨科患者术前等待时间及住院时间，降低高龄骨科患者围手术期并发症的发生率，对于MDT全程管理模式在高龄骨科患者临床中的推广应用，具有一定的指导意义。
- MDT全程管理模式 /
- 高龄骨科患者 /
- 围手术期 /
- 术前等待时间 /
- 住院时间
Abstract: Objective To explore the application effect of whole process management by MDT mode in elderly orthopaedic patients during the peri-operative period. Methods According to the order of admission time, 139 elderly surgical patients who were treated in the Orthopaedics Department of Yuying children's Hospital of the Second Affiliated Hospital of Wenzhou Medical University from March to September 2019 and received the traditional management mode during the peri-operative period were taken as the routine group. Then, 143 elderly patients who were treated in the Department of orthopaedics from October 2019 to April 2020 and used the whole process management by MDT mode during the peri-operative period were selected as the intervention group. The whole process management by MDT mode of pre-operative multidisciplinary team evaluation → intraoperative management → rapid post-operative rehabilitation → discharge follow-up was adopted. The pre-operative waiting time and hospitalisation time of the two groups were compared. The incidence of peri-operative complications, such as joint dysfunction, pressure injury, pulmonary infection and lower extremity deep venous thrombosis, were compared between the two groups. Results The pre-operative waiting time of 2 (2, 4) days in the intervention group was shorter than 6 (3, 7) days in the routine group. The hospitalisation time of 10 (6, 14) days in the intervention group was shorter than the 14 (10, 17) days in the routine group (all P < 0.05). The incidence of peri-operative complications in the intervention group (1.40%) was significantly lower than that in the routine group (10.07%, P < 0.05). Conclusion Application of whole process management by MDT mode in the peri-operative period of elderly orthopaedic patients can effectively shorten the pre-operative waiting time and hospitalisation time of elderly orthopaedic patients and reduce the incidence of peri-operative complications in elderly orthopaedic patients. It has certain guiding significance for the promotion and application of whole process management by MDT mode in the clinical practice of elderly orthopaedic patients.
- Whole process management by MDT mode /
- Elderly orthopaedic patients /
- Peri-operative period /
- Pre-operative waiting time /
- Hospital stay

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表 1 2组高龄骨科患者术前等待时间及住院时间比较[M(P₂₅, P₇₅)，d]

组别	例数	术前等待时间	住院时间
常规组	139	6(3, 7)	14(10, 17)
干预组	143	2(2, 4)	10(6, 14)
Z值		-8.932	-6.130
P值		＜0.001	＜0.001

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表 2 2组高龄骨科患者围手术期并发症的发生情况比较[例(%)]

组别	例数	关节功能障碍	压力性损伤	肺部感染	下肢深静脉血栓形成	合计
常规组	139	2(1.44)	3(2.16)	6(4.32)	3(2.16)	14(10.07)
干预组	143	0	1(0.70)	1(0.70)	0	2(1.40)
注：2组并发症总发生率比较，χ²=9.908，P=0.002。

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