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以血管外科为核心的多学科合作模式在糖尿病足诊治中的应用及效果
张伟,王建纲,邵泉,武静,段成刚,马瑞鹏,李泽峰
0
太原钢铁集团有限公司总医院山西医科大学附属第六医院血管外科太原 030000
摘要:
目的:研究构建以血管外科为核心的多学科合作模式在糖尿病足诊治中的应用及效果。方法:选取2018年1月—2019年1月入住我院的DF患者100例,分为多学科协作组(MT组)49例,单一学科治疗组(LT组)51例,MT组由血管外科为核心结合创面伤口科、内分泌科、骨科、伤口护理单元专科护士共同组成的多学科团队对DF患者进行诊治,LT组采用单一科室对DF患者诊治,比较术前、术后3、6、9、12个月时两组的溃疡面积变化,空腹血糖控制水平,以及SF-36生活质量量表评分的差别;并比较两组病变血管由血管外科干预比例以及大截肢发生率的差异。结果:术前,两组间溃疡面积差异无统计学意义,术后3、6、9、12个月,MT组和LT组溃疡面愈合面积均逐渐缩小,且MT组溃疡面积小于LT组,差异有统计学意义(P<0.05)。术后3个月,两组血糖均控制较为理想,均低于7.0 mmol/L,术后6、9、12个月时,MT组空腹血糖水平均低于7.0 mmol/L,而LT组血糖水平高于该水平,MT组术后空腹血糖控制较LT组更为理想。术前,两组间SF-36生活质量量表评分比较差异无统计学意义(P>0.05),术后6、9、12个月时,MT组的SF-36生活质量量表评分均高于LT组,差异有统计学意义(P<0.05)。MT组病变血管的干预率明显高于LT组(96.4% vs 51.7%),MT组大截肢发生率明显低于LT组(2.0% vs 15.7%),差异均有统计学意义(P<0.05)。结论:多学科协作的诊治模式可为糖尿病足患者提供最佳的治疗效果,非常值得临床推广,然而糖尿病足多学科的组成模式并非固定不变,需要不断调整完善。
关键词:  糖尿病足  多学科合作  大截肢  SF-36生活质量量表
DOI:10.3969/j.issn.1007-6948.2021.02.010
投稿时间:2020-06-19
基金项目:太原市医学重点学科高端人才培养计划(20190929)
Application and Effect of Multidisciplinary Cooperation Model Centered on Vascular Surgery in the Diagnosis and Treatment of Diabetic Foot
ZHANG Wei,WANG Jian-gang,SHAO Quan
Department of Vascular Surgery, The General Hospital of TISCO, The Sixth Affiliated Hospital of Shanxi Medical University, Taiyuan 030000, China
Abstract:
Objective To study the application and effect of multi-disciplinary cooperation mode with vascular surgery as the core in the diagnosis and treatment of diabetic foot. Methods 100 diabetic foot patients were admitted to our hospital. At last, 49 patients in multi-disciplinary cooperative group (MT) and 51 patients in single disciplinary treatment group (LT) were obtained by using the method of propensity score matching (PSM). In the MT group, the diabetic foot ulcer patients were diagnosed and treated by a multi-disciplinary team consisting of vascular surgery as the core and specialized nurses in wound department, endocrinology department, orthopaedics department and wound care unit. In the LT group, the diabetic foot ulcer patients were diagnosed and treated by a single department and the operation was performed in 3 months, 6 months, 9 months and 12 months after operation. There were differences in ulcer area, fasting blood glucose control level and SF-36 quality of life scale between the two groups at multiple time nodes. The differences of the proportion of surgical intervention and the incidence of major amputation between the two groups were compared. Results With the time passing, the healing area of ulcer surface in MT group and its group decreased gradually, and the difference between the two groups in time point was statistically significant (P<0.05). At the 3rd month after operation, the blood glucose in both groups was well controlled, which was lower than 7.0 mmol/L. At the 6th, 9th and 12th month after operation, the fasting blood glucose in MT group was lower than 7.0 mmol/L on average, while the blood glucose level in LT group was higher than this level. The fasting blood glucose control in MT group was more ideal than that in LT group. The quality of life score of MT group was higher than that of LT group at all follow-up time points (P < 0.05), which the difference was statistically signi?cant. It indicated that the quality of life of MT group was better than that of LT group. The number of target vascular intervention in MT group was signi?cantly higher than that in LT group and the incidence of large amputation in MT group was signi?cantly lower than that in LT group. Conclusion The diagnosis and treatment mode of multidisciplinary cooperation can provide the best treatment effect for diabetic foot patients, which is worthy of clinical promotion. However, the composition mode of diabetic foot multidisciplinary is not ?xed, but it needs constant adjustment and improvement.
Key words:  Diabetic foot  multidisciplinary cooperation  major amputation  the MOS 36-item short form health survey

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