本文選題：胃腸動力性疾病 + 多學科協(xié)作　； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：背景:胃腸動力性疾病系指因胃腸動力紊亂引起的主要以各種消化道癥狀為臨床表現(xiàn)的胃腸道疾病。主要包括功能性胃腸病,如功能性消化不良、功能性便秘、腸易激綜合征等;此外一些器質(zhì)性消化道疾病及其他系統(tǒng)疾病、術(shù)后、全身性疾病,如胃食管反流病、消化性潰瘍、糖尿病、系統(tǒng)型硬化癥、腫瘤術(shù)后等,可同時伴有胃腸動力異常。近年來,胃腸動力性疾病發(fā)病率逐漸上升,其機制尚未完全明確,臨床表現(xiàn)多樣化,常伴隨多器官、系統(tǒng)受累,診斷難、易誤診、治療方案個體化程度高,一些復雜疑難的胃腸動力性疾病在診治過程中很難由單一學科順利完成,常常需要多學科專家共同協(xié)商、綜合考慮,才能達到快速有效診治疾病的目標。多學科協(xié)作(multidisciplinary team,MDT)診療目前已在各個國家的癌癥診治中得到廣泛推廣,并在一些其他疾病領(lǐng)域,如代謝性疾病、呼吸系統(tǒng)疾病、心腦血管疾病及耐藥菌控制等領(lǐng)域被廣泛應用,療效顯著。但除"胃食管反流病多學科診療"在國內(nèi)外得到推廣與發(fā)展,系統(tǒng)的在胃腸動力性疾病中應用多學科診療模式的研究較少,在文獻及報道中鮮被提及。目的:探討多學科診療模式在胃腸動力性疾病中應用的主要形式、主體構(gòu)成、診療效果、相關(guān)制度,并提出了存在的問題,以期為胃腸動力性疾病的診治提供新的思路。方法:本研究納入符合標準的參加胃腸動力性疾病多學科診療的807例患者,根據(jù)參與會診的學科數(shù)及多學科會診方式,分為MDT Green Circle組(3個學科及以下參與,n=786)與MDTMeeting組(4個學科及以上參與,n=21)。采集納入研究患者的臨床資料:一般資料,多學科診療基本情況(主要癥狀、會診模式、參與學科、會診目的、最終診斷、治療方案),效果評價,患者滿意度調(diào)查等以觀察胃腸動力性疾病兩種多學科診療模式的病例特點及診療效果。此外,通過典型病例報告具體闡明胃腸動力性疾病多學科診療的流程、效果等。采集的數(shù)據(jù)均輸入SPSS22.0軟件包進行處理,計數(shù)資料采用百分比表示并進行卡方檢驗,符合正態(tài)分布的計量資料采用均數(shù)±標準差表示,不符合正態(tài)分布的用中位數(shù)表示,兩兩對比采用t檢驗,均以檢驗結(jié)果P0.05表示差異具有統(tǒng)計學意義。結(jié)果1.參加MDT Green Circle診療模式的會診病例數(shù)遠多于參加MDT Meeting診療模式的病例數(shù)。2.MDT Green Circle組病例特點分析(1)以上消化道癥狀為主的會診病例數(shù)為494例,約占63%;以下消化道癥狀為主的會診病例數(shù)為175例,約占22%;上、下消化道癥狀重疊的會診病例數(shù)為117例,約占15%。(2)以上消化道疾病為主的會診病例中,患者年齡多集中分布于40-59歲(49%);以下消化道疾病為主的會診病例中,患者年齡多集中分布于60-79歲(45%),上、下消化道癥狀重疊的會診病例中,患者年齡多集中分布于40-59歲(41%)。(3)MDT Green Circle模式涉及的學科主要有:消化內(nèi)科、呼吸內(nèi)科、耳鼻候科、心身醫(yī)學科。(4)最終確診疾病主要有:胃食管反流病、功能性食管病、功能性便秘、功能性消化不良與腸易激綜合征的重疊等。3.MDT Meeting組病例特點分析(1)患者年齡多集中分布于40-59歲,約占會診病例總數(shù)66%。(2)MDT Meeting涉及的學科主要有消化內(nèi)科、胃腸外科、心身醫(yī)學科、中醫(yī)科。(3)會診目的主要有:排便困難、胸骨后燒灼感、腫瘤及術(shù)后。最終診斷前三位疾病:功能性便秘、難治性胃食管反流病、惡性腫瘤。(4)主要診治方案:心理治療、藥物治療、生活指導、內(nèi)鏡下治療或介入治療、手術(shù)治療。4.納入研究的會診病例中,功能性胃腸病患者所占比例較高,且MDT Green Circle 組高于 MDTMeeting 組(P0.05)。5.兩種會診模式均取得了比較滿意的診療效果:MDT Green Circle組總有效率達79%,MDT Meeting組總有效率達62%。6.病例報告中,患者通過多學科協(xié)作診治,得到了明確的診斷及個體化治療方案,經(jīng)過規(guī)律的治療,患者逐漸恢復了正常的排便習慣,病情得到有效緩解。結(jié)論1.多學科協(xié)作診療在胃腸動力性疾病的診治中起著積極作用。2.MDT Green Circle模式是患者更易接受、應用更為廣泛的多學科會診方式。3.典型病例的分析報告提示MDT診療模式可有效解決了患者的問題,提高了診療效果及滿意度。
[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.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R57

【參考文獻】

相關(guān)期刊論文 前9條

1 尚妍妍;徐峰;;功能性胃腸病伴焦慮、抑郁狀態(tài)及其與胃腸道癥狀積分的相關(guān)性[J];世界華人消化雜志;2016年19期

2 鄒兵兵;余昌俊;;多學科診療引領(lǐng)模式在胃腸外科臨床教學中的應用探討[J];安徽醫(yī)學;2016年03期

3 李鵬超;黃華興;朱俊棟;王巍;呂強;;多學科診療的臨床教學實踐體會[J];科技視界;2016年08期

4 梅俏;許建明;李素文;許業(yè)傳;;肝膽胰多學科診療模式在消化內(nèi)科臨床教學中的作用[J];安徽醫(yī)藥;2015年09期

5 Hyung Joon Yim;Sang Jun Suh;Soon Ho Um;;Current management of hepatocellular carcinoma:An Eastern perspective[J];World Journal of Gastroenterology;2015年13期

6 孟翔凌;羅曉明;汪正廣;祁義軍;吳文涌;李霆;方茂勇;胡乃中;王偉;汪偉民;徐鳳玲;;以SICU為平臺,多學科協(xié)作診治重癥急性胰腺炎的臨床研究[J];肝膽外科雜志;2015年01期

7 彭麗華;;胃腸動力障礙性疾病檢測技術(shù)的應用與進展[J];解放軍醫(yī)學院學報;2015年03期

8 齊伯貞,任萬英,章文寶,黃培;胃食管反流病38例誤診原因分析[J];臨床誤診誤治;2000年04期

9 王俊萍;段麗萍;葉紅軍;吳子剛;鄒兵;;功能性便秘患者的精神心理狀況及生活質(zhì)量評估[J];中華內(nèi)科雜志;2008年06期

，

本文編號：1775717