胃肠动力性疾病多学科诊疗模式的研究及典型病例报告

发布时间：2018-04-20 02:01

本文选题：胃肠动力性疾病 + 多学科协作　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景:胃肠动力性疾病系指因胃肠动力紊乱引起的主要以各种消化道症状为临床表现的胃肠道疾病。主要包括功能性胃肠病,如功能性消化不良、功能性便秘、肠易激综合征等;此外一些器质性消化道疾病及其他系统疾病、术后、全身性疾病,如胃食管反流病、消化性溃疡、糖尿病、系统型硬化症、肿瘤术后等,可同时伴有胃肠动力异常。近年来,胃肠动力性疾病发病率逐渐上升,其机制尚未完全明确,临床表现多样化,常伴随多器官、系统受累,诊断难、易误诊、治疗方案个体化程度高,一些复杂疑难的胃肠动力性疾病在诊治过程中很难由单一学科顺利完成,常常需要多学科专家共同协商、综合考虑,才能达到快速有效诊治疾病的目标。多学科协作(multidisciplinary team,MDT)诊疗目前已在各个国家的癌症诊治中得到广泛推广,并在一些其他疾病领域,如代谢性疾病、呼吸系统疾病、心脑血管疾病及耐药菌控制等领域被广泛应用,疗效显著。但除"胃食管反流病多学科诊疗"在国内外得到推广与发展,系统的在胃肠动力性疾病中应用多学科诊疗模式的研究较少,在文献及报道中鲜被提及。目的:探讨多学科诊疗模式在胃肠动力性疾病中应用的主要形式、主体构成、诊疗效果、相关制度,并提出了存在的问题,以期为胃肠动力性疾病的诊治提供新的思路。方法:本研究纳入符合标准的参加胃肠动力性疾病多学科诊疗的807例患者,根据参与会诊的学科数及多学科会诊方式,分为MDT Green Circle组(3个学科及以下参与,n=786)与MDTMeeting组(4个学科及以上参与,n=21)。采集纳入研究患者的临床资料:一般资料,多学科诊疗基本情况(主要症状、会诊模式、参与学科、会诊目的、最终诊断、治疗方案),效果评价,患者满意度调查等以观察胃肠动力性疾病两种多学科诊疗模式的病例特点及诊疗效果。此外,通过典型病例报告具体阐明胃肠动力性疾病多学科诊疗的流程、效果等。采集的数据均输入SPSS22.0软件包进行处理,计数资料采用百分比表示并进行卡方检验,符合正态分布的计量资料采用均数±标准差表示,不符合正态分布的用中位数表示,两两对比采用t检验,均以检验结果P0.05表示差异具有统计学意义。结果1.参加MDT Green Circle诊疗模式的会诊病例数远多于参加MDT Meeting诊疗模式的病例数。2.MDT Green Circle组病例特点分析(1)以上消化道症状为主的会诊病例数为494例,约占63%;以下消化道症状为主的会诊病例数为175例,约占22%;上、下消化道症状重叠的会诊病例数为117例,约占15%。(2)以上消化道疾病为主的会诊病例中,患者年龄多集中分布于40-59岁(49%);以下消化道疾病为主的会诊病例中,患者年龄多集中分布于60-79岁(45%),上、下消化道症状重叠的会诊病例中,患者年龄多集中分布于40-59岁(41%)。(3)MDT Green Circle模式涉及的学科主要有:消化内科、呼吸内科、耳鼻候科、心身医学科。(4)最终确诊疾病主要有:胃食管反流病、功能性食管病、功能性便秘、功能性消化不良与肠易激综合征的重叠等。3.MDT Meeting组病例特点分析(1)患者年龄多集中分布于40-59岁,约占会诊病例总数66%。(2)MDT Meeting涉及的学科主要有消化内科、胃肠外科、心身医学科、中医科。(3)会诊目的主要有:排便困难、胸骨后烧灼感、肿瘤及术后。最终诊断前三位疾病:功能性便秘、难治性胃食管反流病、恶性肿瘤。(4)主要诊治方案:心理治疗、药物治疗、生活指导、内镜下治疗或介入治疗、手术治疗。4.纳入研究的会诊病例中,功能性胃肠病患者所占比例较高,且MDT Green Circle 组高于 MDTMeeting 组(P0.05)。5.两种会诊模式均取得了比较满意的诊疗效果:MDT Green Circle组总有效率达79%,MDT Meeting组总有效率达62%。6.病例报告中,患者通过多学科协作诊治,得到了明确的诊断及个体化治疗方案,经过规律的治疗,患者逐渐恢复了正常的排便习惯,病情得到有效缓解。结论1.多学科协作诊疗在胃肠动力性疾病的诊治中起着积极作用。2.MDT Green Circle模式是患者更易接受、应用更为广泛的多学科会诊方式。3.典型病例的分析报告提示MDT诊疗模式可有效解决了患者的问题,提高了诊疗效果及满意度。
[Abstract]:Background: gastrointestinal motility disease refers to gastrointestinal diseases, which are mainly caused by gastrointestinal motility disorders. It mainly includes functional gastrointestinal diseases such as functional dyspepsia, functional constipation, irritable bowel syndrome, and some organic digestive diseases and other systemic diseases, postoperative, systemic diseases. Diseases such as gastroesophageal reflux disease, peptic ulcer, diabetes, systemic sclerosis, and postoperative tumor can be accompanied by abnormal gastrointestinal motility. In recent years, the incidence of gastrointestinal motility is rising gradually, its mechanism is not completely clear, the clinical manifestations are diversified, often accompanied by multiple organs, system involvement, difficult diagnosis, easy misdiagnosis, individualized treatment scheme. High degree, some complicated and difficult gastrointestinal motility diseases are difficult to be successfully completed by a single subject in the process of diagnosis and treatment. They often need multidisciplinary experts to consult together to achieve the goal of rapid and effective diagnosis and treatment of the disease. Multidisciplinary team (MDT) is currently in the diagnosis and treatment of cancer in various countries. It has been widely used in some other fields, such as metabolic diseases, respiratory diseases, cardiovascular and cerebrovascular diseases and drug resistant bacteria control. But the multidisciplinary diagnosis and treatment of gastroesophageal reflux disease has been popularized and developed at home and abroad, and the multidisciplinary diagnosis and treatment model is applied to gastrointestinal motility diseases. It is rarely mentioned in the literature and report. Objective: to discuss the main forms of the multidisciplinary diagnosis and treatment model in the gastrointestinal motility diseases, the main body composition, the diagnosis and treatment effect, the related system, and put forward the existing problems, in order to provide new ideas for the diagnosis and treatment of gastrointestinal motility diseases. 807 patients with multidisciplinary diagnosis and treatment of gastrointestinal motility were divided into group MDT Green Circle (3 subjects and following participation, n=786) and MDTMeeting group (4 subjects and above participation, n=21), according to the number of subjects involved in consultation and the method of multidisciplinary consultation. General information, basic information of multidisciplinary diagnosis and treatment were collected. The main symptoms, the consultation mode, the participation subject, the purpose of consultation, the final diagnosis, the treatment plan), the effect evaluation, the patient satisfaction survey and so on in order to observe the case characteristics and diagnosis and treatment effect of the two multidisciplinary diagnosis and treatment modes of gastrointestinal motility diseases. The data collected are all processed by SPSS22.0 software package, the count data are expressed in percentage and chi square test. The measurement data that conforms to normal distribution are expressed in mean number of standard deviations, the median is not in line with the normal distribution, and the 22 comparison uses the t test, and the results P0.05 show that the difference has statistical meaning. Results 1. the number of consultation cases in the MDT Green Circle diagnosis and treatment mode was far more than that of the.2.MDT Green Circle group who participated in the MDT Meeting diagnosis and treatment model. (1) the number of cases based on the symptoms of digestive tract was 494, accounting for about 63%; the number of cases of the following digestive tract symptoms was 175, accounting for 22%; upper and lower. The number of patients with overlapping symptoms was 117 cases, which accounted for about 15%. (2) of the digestive tract diseases. The age of the patients was 40-59 years (49%), and the age of the patients with digestive tract diseases was 60-79 years (45%), and the age of the patients with overlapping symptoms of the lower digestive tract was aged (45%). More concentrated in 40-59 years (41%). (3) MDT Green Circle model involves major subjects: digestive medicine, respiratory medicine, otolaryngology, psychosomatic medicine. (4) the final confirmed diseases include gastroesophageal reflux disease, functional esophagus disease, functional constipation, reactive dyspepsia and irritable bowel syndrome in the.3.MDT Meeting group. Characteristics analysis (1) the age of the patients was concentrated at the age of 40-59, accounting for 66%. (2) of the total number of consultation cases (2) MDT Meeting involved in the major subjects of digestive medicine, gastrointestinal surgery, psychosomatic medicine, and Department of traditional Chinese medicine. (3) the main purpose of consultation was defecation difficulty, post sternum burning sensation, tumor and postoperative. The final diagnosis of three diseases: functional constipation, refractory sex Gastroesophageal reflux disease, malignant tumor. (4) the main diagnosis and treatment program: psychotherapy, drug treatment, life guidance, endoscopic treatment or interventional therapy, and surgical treatment of.4. included in the study cases, the proportion of patients with functional gastrointestinal diseases is higher, and the MDT Green Circle group is higher than the MDTMeeting group (P0.05).5. two consultation models have been obtained The effective rate of diagnosis and treatment was satisfactory: the total effective rate of MDT Green Circle group was 79%, and the total effective rate of group MDT Meeting reached 62%.6. case report. The patients were diagnosed and treated by multidisciplinary cooperation. The patients got a definite diagnosis and individualized treatment plan. After regular treatment, the patients gradually recovered the normal defecation habit and the condition was effectively relieved. Conclusion 1. Multidisciplinary cooperative diagnosis and treatment in the diagnosis and treatment of gastrointestinal motility disease plays an active role in the.2.MDT Green Circle model is more acceptable to the patients. The analysis report of the typical cases of.3. with a more extensive multidisciplinary consultation method suggests that the MDT diagnosis and treatment model can effectively solve the patient's problems and improve the diagnosis and treatment effect and satisfaction.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R57

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