远程会诊系统在ICU多器官功能障碍综合症患者中的应用

发布时间：2018-02-25 06:26

  本文关键词： 远程会诊系统 重症监护病房 MODS　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨通过远程会诊系统指导治疗方案对MODS患者临床疗效,为远程会诊系统对MODS患者的应用价值提供根据。材料和方法1.一般资料连续性选择山东大学附属省立医院东院ICU病房中自2014年1月至2015年4月期间治疗的MODS患者42例,其中使用常规治疗方案的MODS患者31例,并组成常规方案组,本院使用远程会诊系统指导治疗方案的MODS患者11例,并组成远程会诊组。并对患者进行随访,随访时间为1月。2.方法2.1搜集上述患者在转入ICU后住院时间、APACHEII评分、平均动脉压(MAP)血乳酸(Lac)、天冬氨酸氨基转移酶(AST)、谷氨酸氨基转移酶(ALT)、总胆红素(TBIL)、尿素氮(BUN)、肌酐(Cr)水平、尿量、住院天数、病死率。2.2结合2.1中搜集到的资料,通过比较常规方案组与远程会诊组患者WBC计数,分析应用远程会诊系统指导治疗方案对炎症反应的影响。2.3结合2.1中搜集到的资料,通过比较常规方案组与远程会诊组患者BUN、Cr、尿量,分析应用远程会诊系统指导治疗方案对患者肾功能的影响。2.4结合2.1中搜集到的资料,通过比较常规方案组与远程会诊组患者AST、ALT、TBIL,分析应用远程会诊系统指导治疗方案对患者肝功能的影响。2.5结合2.1中搜集到的资料,通过比较常规方案组与远程会诊组患者MAP、Lac分析应用远程会诊系统指导治疗方案对患者血液灌注情况的影响。2.6结合2.1中搜集到的资料,通过比较常规方案组与远程会诊组患者APACHE Ⅱ评分,分析应用远程会诊系统指导治疗方案对整体疗效的影响。2.7结合2.1中搜集到的资料,通过比较常规方案组与远程会诊组患者住院天数,分析应用远程会诊系统指导治疗方案对住院时间的影响。2.8结合2.1中搜集到的资料,通过比较常规方案组与远程会诊组患者28d病死率,分析应用远程会诊系统指导治疗方案对患者28d生存率的影响。3.统计分析处理数据以均数±标准差(X±s)表示；采用SPSS 19统计分析软件进行统计分析。正态分布且方差齐样本采用t检验,非正态分布样本采用秩和检验,计数资料采用x2检验及其校正公式。P值均取0.05为显著性标准。结果通过应用远程会诊系统,专家可以根据患者情况提出针对性的治疗建议,优化现有的治疗方案,能有效提高治疗效率,例如更合理的使用抗生素、更有效率的开展血液净化治疗等,使MODS患者能在更短的时间内改善心、肺、肝、肾等的功能,再通过指导后续治疗,使患者得到更完善的治疗方案,从而减少患者的住院时间,并进一步减少患者的病死率,达到预期的治疗效果。结论1.应用远程会诊系统指导治疗方案能有效改善MODS患者的临床治疗效果。2.通过远程会诊系统指导治疗方案可以减少MODS患者的住院时间。3.使用远程会诊系统指导治疗方案有效降低MODS患者28d的病死率。
[Abstract]:Objective: to explore the clinical efficacy of remote consultation system in guiding the treatment of MODS patients. Materials and methods for the application of remote consultation system to MODS patients. 1. General data continuity selection of 42 MODS patients who were treated from January 2014 to April 2015 in ICU ward of Eastern Hospital affiliated to Shandong University. Among them, 31 patients with MODS were treated with routine therapy, and 11 patients with MODS were treated by remote consultation system. The patients were followed up. Methods the follow-up time was from January to January. Methods the Apache II score, mean arterial pressure (map) blood lactate, aspartate aminotransferase (AST), glutamate aminotransferase (alt), total bilirubin (Tbilirubin), urea nitrogen (bun), creatinine (Cr), urine volume were collected after admission to ICU. Days of hospitalization, mortality. 2.2 combined with the data collected in 2.1. By comparing the WBC counts of patients in routine and remote consultation groups, the effects of remote consultation system on inflammatory response were analyzed. By comparing the amount of BUNC Cr, urine of patients in routine and remote consultation groups, we analyzed the effect of remote consultation system on renal function of patients. 2.4 and 2.1 data were collected. By comparing AST alt TBILs between routine and remote consultation groups, the effects of remote consultation system on liver function of patients were analyzed. 2.5 and 2.1 data were collected. The effects of remote consultation system on patients' blood perfusion were analyzed by comparing the data collected in the routine protocol group and remote consultation group. 2. 6 combined with 2. 1. 1. By comparing the APACHE 鈪，

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