多学科团队协作模式在糖尿病足介入手术患者护理中的应用价值-现代医学

多学科团队协作模式在糖尿病足介入手术患者护理中的应用价值

单位：1. 中国人民解放军东部战区空军医院内分泌科, 江苏南京 210000;
2. 中国人民解放军东部战区空军医院糖尿病足中心, 江苏南京 210000;
3. 安徽医科大学临床医学院, 安徽合肥 230000

分类号：R587.2;R473.58

出版年·卷·期（页码）：2019·47·第十二期（1511-1516）

摘要：

目的： 探讨多学科团队（MDT）协作模式在糖尿病足介入手术患者护理中的临床应用效果。方法： 选取2017年10月至2018年10月中国人民解放军东部战区空军医院收治行糖尿病足介入手术治疗的患者109例，以随机数字表法分为对照组（55例）和观察组（54例），观察组采取MDT护理模式，对照组采取常规护理模式。对比两组患者住院时间、住院费用，糖化血红蛋白指标变化，术后并发症发生率，焦虑、抑郁情绪变化，健康教育效果和护理满意度情况。结果： 观察组住院时间和住院费用明显低于对照组，差异有统计学意义（P<0.05）；观察组和对照组糖化血红蛋白水平入院时比较差异无统计学意义（P>0.05），经住院期间护理后，出院时两组糖化血红蛋白水平均低于入院时，差异有统计学意义（P<0.05），且观察组糖化血红蛋白降低量相较于对照组更显著，差异有统计学意义（P<0.05）；观察组术后并发症发生率明显低于对照组，差异有统计学意义（P<0.05）；观察组和对照组焦虑、抑郁评分入院时差异无统计学意义（P>0.05），经住院期间护理后，出院时两组的焦虑、抑郁评分均低于入院时，差异有统计学意义（P<0.05），且观察组焦虑、抑郁评分降低量相较于对照组更显著，差异有统计学意义（P<0.05）；观察组的健康教育效果得分和护理满意度得分均明显高于对照组，差异有统计学意义（P<0.05）。结论： MDT协作模式在糖尿病足介入手术患者护理中的应用可缩短患者的住院时间，降低住院费用，改善患者血糖水平的控制，降低术后并发症发生率，增强患者对健康教育知识的掌握和护理满意度，减轻患者的心理负担，协助临床总体疗效的提高，改善患者生活质量。

Objective: To explore the clinical application value of multi-disciplinary team (MDT) collaborative mode in the nursing of patients with diabetic foot interventional surgery. Methods: A total of 109 patients who underwent interventional surgery for diabetic foot in Chinese People's Liberation Army' Air Force Hospital of Eastern Theater from October 2017 to October 2018 were enrolled. The patients were randomly divided into the control group (55 cases) and the observation group (54 cases). The observation group took MDT nursing mode, and the control group took the regular care mode. The hospitalization time, hospitalization cost, glycosylated hemoglobin index level, postoperative complication rate, anxiety alteration, depression mood fluctuation, health education effect and nursing satisfaction were compared between the two groups. Results: The hospitalization time and hospitalization cost of the observation group were lower than the control group with the difference being statistically significant (P<0.05). There was no significant difference between the observation group and the control group in the glycosylated hemoglobin level when patients were admitted to the hospital (P>0.05). After nursing, the levels of glycosylated hemoglobin in the two groups were lower than those at the time of admission (P<0.05), and the decreased amount of glycosylated hemoglobin in the observation group was higher than that in the control group after nursing, with the difference being statistically significant (P<0.05). The incidence of postoperative complications was significantly lower than that of the control group (P<0.05). There was no significant difference in the anxiety and depression scores between the observation group and the control group when patients were admitted to the hospital (P>0.05). After nursing, the anxiety and depression scores of the two groups were lower than those at the time of admission, and the difference was statistically significant (P<0.05). The decreased amount of anxiety and depression scores of the observation group were higher than the control group after nursing, with the difference being statistically significant (P<0.05). The health education effect score and nursing satisfaction score of the observation group were significantly higher than the control group, and the difference was statistically significant (P<0.05). Conclusion: The application of MDT collaboration mode in the nursing of patients with diabetic foot intervention surgery could shorten the hospitalization time, reduce the hospitalization cost, better the moderation of blood glucose level, reduce the incidence rate of postoperative complications, and enhance the patient's knowledge of health education and nursing satisfaction, lower the psychological burden of patients, help improving the overall clinical efficacy, and ameliorate the quality of life of patients.

参考文献：

[1] LA FONTAINE J,BHAVAN K,TALAL T K,et al.Current concepts in the surgical management of acute diabetic foot infections[J].Foot (Edinb),2014,24(3):123-127.
[2] 潘俊霞,邢星,闵捷.社区2型糖尿病患者居民健康素养水平的条件Logistic回归分析[J].东南大学学报(医学版),2016,35(6):889-893.
[3] EVERETT E,MATHIOUDAKIS N.Update on management of diabetic foot ulcers[J].Ann N Y Acad Sci,2018,1411(1):153-165.
[4] JEYARAMAN K,BERHANE T,HAMILTON M,et al.Mortality in patients with diabetic foot ulcer:a retrospective study of 513 cases from a single Centre in the Northern Territory of Australia[J].BMC Endocr Disord,2019,19(1):1.
[5] 朱湘萍,刘智情.血管外科糖尿病足介入治疗围手术期护理体会[J].双足与保健,2018(16):93-94.
[6] 白春花,陈莉.协同护理模式对结肠造口患者心理健康及生存质量影响的研究[J].现代医学,2016,44(9):1254-1258.
[7] 钱明兰,王爱红,黄私伟,等.MDT护理模式在结肠癌患者围术期护理中的应用效果[J].国际护理学杂志,2018,37(18):2456-2460.
[8] 杜姗菱,符玉莲,袁美,等.MDT延续护理在肺结核合并2型糖尿病患者中的应用[J].海南医学,2017,28(10):1719-1720.
[9] HASSAN Z M.Mobile phone text messaging to improve knowledge and practice of diabetic foot care in a developing country:Feasibility and outcomes[J].Int J Nurs Pract,2017,23(S1):e1-6.
[10] FONT-JIMENEZ I,LLAURADO-SERRA M,ROIG-GARCIA M,et al.Retrospective study of the evolution of the incidence of non-traumatic lower-extremity amputations (2007-2013) and risk factors of reamputation[J].Prim Care Diabetes,2016,10(6):434-441.
[11] 吕新霞.学科协作模式在老年糖尿病患者护理中的效果分析[J/OL].实用临床护理学电子杂志,2018,3(27):33,41.
[12] 韩春茂,沈月宏.糖尿病足诊疗路径实践——团队合作[Z].上海:93-95.
[13] 雷璟,张晓薇,李娟,等.多学科协作模式护理对老年糖尿病患者住院时间及并发症的影响[J].实用临床医药杂志,2017,21(18):128-129,132.
[14] 宋亚军.多学科协作型糖尿病教育模式对糖尿病患者代谢指标的影响[J].解放军护理杂志,2008,25(10):43-44,66.
[15] HICKS C W,SELVARAJAH S,MATHIOUDAKIS N,et al.Burden of Infected Diabetic Foot Ulcers on Hospital Admissions and Costs[J].Ann Vasc Surg,2016,33:149-158.
[16] HICKS C W,SELVARAJAH S,MATHIOUDAKIS N,et al.Trends and determinants of costs associated with the inpatient care of diabetic foot ulcers[J].J Vasc Surg,2014,60(5):1247-1254.
[17] HICKS C W,CANNER J K,KARAGOZLU H,et al.Quantifying the costs and profitability of care for diabetic foot ulcers treated in a multidisciplinary setting[J].J Vasc Surg,2019,70(1):233-240.
[18] 方旭,楚同彬,贾树华.不同预后糖尿病足坏疽患者心理障碍及其相关因素[J].中国临床康复,2005,9(8):32-34.
[19] 李红梅.多学科协作模式在老年糖尿病患者护理中的应用价值分析[J].中国现代医生,2018,56(16):146-148.
[20] BETSCH D,GAO Z,MUGFORD G,et al.Optimizing Glycemic Control in Adults With Type 1 or Type 2 Diabetes Attending a Multidisciplinary Foot Clinic[J].Can J Diabetes,2018,42(4):437-441.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录