摘要
为探讨综合医院(三甲)肛肠急重症"多学科协作诊疗"(MDT)模式的构建和应用,回顾性分析2009年8月至2016年12月山西省中西医结合医院(三甲)肛肠科内/外急重症158例患者的临床资料,将其设为观察组,临床应用MDT模式诊疗;同时回顾性分析2000年1月至2009年7月山西省太原市中医医院(二甲)肛肠科急诊或急会诊93例患者的临床资料,将其设为对照组,临床采用单会诊(外邀或被邀)形式诊疗。对2组患者的既往暴露因素、干预效果及优势比(OR)等数据、病例特征和处理措施,以及疗效或结果等临床资料,进行对照分析。结果显示,观察组158例,痊愈51例,好转83例,总有效率84.8%(134/158);无效24例中,30 d内死亡10例,近期病死率6.3%(10/158),随访1年死亡3例。对照组93例,痊愈23例,好转45例,总有效率73.1%(68/93);无效25例中,30 d内死亡3例,院内病死率3.2%(3/93)。2组比较,观察组总有效率显著高于对照组(χ~2=5.094, P=0.024);但2组院内病死率比较,差异无统计学意义(χ~2=0.603, P=0.437)。观察组干预效果显著优于对照组(χ~2=5.094,P=0.024,OR=5.95)。结果表明,综合医院肛肠科相关急重症病例多于基层医院,且处理能力,救治水平也高于基层医院,肛肠急重症MDT模式疗效优于单会诊模式。
In order to explore the construction of multi subject diagnosis g〉. treatment cooperation mode （MDT） and its application in acute and severe colorectal diseases（CD） by 3A-level comprehensive hospi- tals,authors retrospectively analyzed the clinical data of 158 cases in Shanxi provincial hospital （dA） of in- tegration of Chinese and western medicine, coloproctological department （2009-08 -- 2016-12）, grouped them as observation group（received MDT-mode）,and grouped 93 cases emergency treatment and acute consultation in Taiyuan city＇s hospital of TCM （2A） as control group（received single consultation,invita- tion or be invited,2000-01--2009-07）;compared and analyzed both groups＇ following materials such as the data of past exposed factor,interventive efficacy and advantage＇s ratio clinical data including case＇s features, management measure and effect （or outcome）.As results,in observation group 51 cases were cured,83 got improved,total effective rate was up to 84.8%（134/158）;in the 24 were of non-response,within 30 days 10 died,short-term case fatality ratio was 6.3%（10/158）,in follow-up of 1 year 3 died,meanwhile,in control group respectively 23 cases, 45,73.1%（68/93） ;25,3,3.2% （3/93） ,thus in total effective rate observation group was significantly higher than control group（;（2 5.094, P =0.024, P 〈40.05）, but in inhospital case fatality ratio there was no statistical difference between both groups（x2 =0.603, P =0.437, P 〉0.05） ;Al- so,in intervention efficacy observation group was superior to control group （x2= 5.094, P〈0. 024, OR = 5.95, P 〈0.05）.Results show that in 3A-level hospitals above cases are more than that in lower-level hos- pital,and with higher management and treatment capacities,the effect of MDT mode is superior to the lat- ter for acute and severe CD.
作者
刘声
陈海滨
刘青云
LIU Sheng;CHEN Hal-bin;LIU Qing-yun(Shanxi Provincial Hospital of Integration of Chinese and Western Medicine,Taiyuan,Shanxi 030013;Kaifeng Municipal Hospital of TCM,Henan 475000)
出处
《中国肛肠病杂志》
2018年第9期18-21,共4页
Chinese Journal of Coloproctology
关键词
肛肠科
急重症
多学科协作诊疗
分级诊疗
综合医院
Coloproctological department
Acute and cooperation mode
Classified diagnosis ＆ severe disease
Multi-subject diagnosis
treatment treatment
Comprehensive hospital
