多学科协助团队在肺结核大咯血救治中的临床价值

doi:10.3969/j.issn.1000-6621.2019.10.010

摘要/Abstract

摘要：

目的评估多学科协助团队(multiple disciplinary team,MDT)在肺结核大咯血患者救治中的临床价值。方法选择2017—2018年同济大学附属上海市肺科医院收治的所有肺结核并发大咯血患者200例,将2017年96例患者中符合入选标准的82例患者作为对照组,实施常规护理+窒息风险评估+传统救治模式(止血、开放气道、生命体征监护、气管插管、支气管动脉介入手术等);将2018年104例患者中符合纳入标准的97例患者作为观察组,实施常规护理+窒息风险评估+MDT救治模式(组建MTD团队,制定日常及紧急情况会诊、急救流程)。采用SPSS 20.0软件比较两组患者救治成功的时间、咯血再发生率、咯血相关并发症的发生率、住院时间的差异性,采用χ ²检验或t检验、U检验,均以P<0.05为差异有统计学意义结果实施MDT救治后,观察组患者救治成功的时间[100.0(88.5,119.2)h]、咯血再发生率[2.1%(2/97)]、并发症发生率[3.1%(3/97)]、住院时间[(8.8±2.6)d]均明显低于对照组[分别为268.0(229.3,300.0)h、14.6%(12/82)、13.4%(11/82)、(15.4±4.3)d](U=131.000,P=0.000;χ ²=8.276,P=0.004;χ ²=5.582,P=0.018;t=31.067,P=0.000)。结论在确保紧急救治的基础上对肺结核并发大咯血患者实施 MDT救治,能明显缩短救治成功的时间和住院时间,降低咯血再发生率,减少咯血相关并发症的发生,可在临床加以推广。

关键词: 结核, 肺, 咯血, 急救医疗服务, 学科间信息交流, 临床护理研究

Abstract:

Objective To evaluate the effect of multiple disciplinary team (MDT) in the treatment of massive hemoptysis of pulmonary tuberculosis.Methods A total of 200 patients with pulmonary tuberculosis complicated with massive hemoptysis admitted in Shanghai Pulmonary Hospital Affiliated to Tongji University from 2017 to 2018 were selected. Eighty-two out of 96 patients in 2017 who met the inclusion criteria were selected as control group which implemented conventional nursing, risk assessment of asphyxia and traditional treatment model (hemostasis, airway opening, vital sign monitoring, tracheal intubation, bronchial artery embolization). Ninty-seven out of 104 patients in 2018 who met the inclusion criteria were selected as observation group which implemented conventional nursing, risk assessment of asphyxia and MDT treatment model (MTD Team establishment, making routine and emergency consultation, establishing first aid process). SPSS 20.0 software was used to compare the χ ² test,t test and U test of the time of successful treatment, recurrence rate of hemoptysis, incidence of hemoptysis-related complications and hospitalization time between the two groups,and P<0.05 was considered to be statistically significant.Results After MDT treatment, the time of successful treatment for pulmonary tuberculosis complicated with massive hemoptysis was 100.0(88.5,119.2) h, the recurrence rate of hemoptysis after MDT treatment was 2.1% (2/97), the incidence of hemoptysis-related complications was 3.1% (3/97), the length of hospitalization was average(8.8±2.6) days, which was lower than control group (268.0(229.3,300.0) h, 14.6%(12/82), 13.4%(11/82),(15.4±4.3) d)(U=131.000,P=0.000;χ ²=8.276,P=0.004;χ ²=5.582,P=0.018;t=31.067,P=0.000)).Conclusion On the basis of ensuring the success of treatment, implementing of MDT treatment can shorten the time of successful treatment of pulmonary tuberculosis hemoptysis patients, reduce the recurrence rate of hemoptysis, reduce the occurrence of hemoptysis-related complications and shorten hospitalization time. It can be popularized in clinic.

Key words: Tuberculosis, pulmonary, Hemoptysis, Emergency medical services, Interdisciplinary communication, Clinical nursing research

李郁如,朱毓萍,周景雯,高颖,王琳. 多学科协助团队在肺结核大咯血救治中的临床价值[J]. 中国防痨杂志, 2019, 41(10): 1118-1123. doi: 10.3969/j.issn.1000-6621.2019.10.010

Yu-ru LI,Yu-ping ZHU,Jing-wen ZHOU,Ying GAO,Lin WANG. Clinical value of multidisciplinary assistance team in the treatment of tuberculosis hemoptysis[J]. Chinese Journal of Antituberculosis, 2019, 41(10): 1118-1123. doi: 10.3969/j.issn.1000-6621.2019.10.010

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人口学特征	观察组(97例)	对照组(82例)	χ²值	P值
性别			0.286	0.593
男	65(67.0)	58(70.7)
女	32(33.0)	24(29.3)
年龄组(岁)			0.453	0.797
<30	14(14.4)	11(13.4)
30~	46(47.4)	43(52.4)
>50	37(38.2)	28(34.2)
大咯血发生时间			0.335	0.563
白天(06:00~18:00)	42(43.3)	32(39.0)
夜间(18:01~05:59)	55(56.7)	50(61.0)
并发症^a			0.646	0.724
糖尿病	18(18.6)	14(17.1)
高血压	10(10.3)	9(11.0)
支气管扩张	8(8.2)	10(12.2)
文化程度			0.462	0.794
初中以下	3(3.1)	4(4.9)
初中和高中	67(69.1)	54(65.8)
高中以上	27(27.8)	24(29.3)
病程(月)			1.400	0.496
<6	16(16.5)	12(14.6)
6~	59(60.8)	45(54.9)
>12	22(22.7)	25(30.5)
肺结核诊断类型			0.627	0.429
初治	77(79.4)	61(74.4)
复治	20(20.6)	21(25.6)