天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (8): 833-837.doi: 10.11958/20170691

• 专题 颅脑神经创伤 • 上一篇    下一篇

NICU与非NICU专职医生管理对患者疗效影响的临床比较研究

郭林月 1， 王鹏 1， 高闯 1， 苏万强 1， 黄金浩 1， 钱宇 1， 王佳琪 1， 龚之涛 1， 宋一鸣 1， 孙健 2， 江荣才 2?   

  1. 1 天津医科大学 （邮编 300070）； 2 天津医科大学总医院神经外科
  • 收稿日期:2017-06-13 修回日期:2017-07-24 出版日期:2017-08-15 发布日期:2017-08-15
  • 通讯作者: ∆通讯作者 E-mail: jiang116216@163.com E-mail:guolinyuedabao@163.com
  • 作者简介:郭林月 （1991）， 男， 硕士在读， 主要从事神经外科研究
  • 基金资助:
    国家自然科学基金资助项目 （81671221， 81271359）， 天津市科技计划项目 （14ZCZDSY00179）

The clinical comparative study on the therapeutic effects of NICU patients implemented by NICU professional doctors and non-NICU professional doctors

GUO Lin-yue1, WANG Peng1, GAO Chuang1, SU Wan-qiang1, HUANG Jin-hao1, QIAN Yu1, WANG Jia-qi1, GONG Zhi-tao1, SONG Yi-ming1, SUN Jian2， JIANG Rong-cai2?   

  1. 1 Tianjin Medical University, Tianjin 300070, China; 2 Department of Neurosurgery, Tianjin Medical University General Hospital
  • Received:2017-06-13 Revised:2017-07-24 Published:2017-08-15 Online:2017-08-15
  • Contact: △Corresponding Author E-mail:jiang116216@163.com E-mail:guolinyuedabao@163.com

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摘要： 目的 探讨神经外科重症监护单元（NICU）患者的治疗管理模式对疗效的影响。方法 以本 NICU 实行 NICU 专职医生管理时间 2015 年 8 月 3 日为节点， 将 2015 年 2 月 3 日—2016 年 2 月 3 日收治的 NICU 住院患者分 为非 NICU 专职医生管理 （NNPDI） 组和 NICU 专职医生管理 （NPDI） 组， 分别由非专职医生和专职医生主导 NICU 患 者的诊疗工作。对患者住院时间、 并发症及预后等进行比较。结果 NPDI 组患者平均住 NICU 时间较 NNPDI 组延 长， 水电解质失调发生率低于 NNPDI 组 （P＜0.05）； 2 组间呼吸机相关性肺炎、 肝肾功能异常、 颅内感染、 应激性溃疡 等的发生率差异无统计学意义（P＞0.05）。NPDI 组转诊至其他病区比例及病死率低于 NNPDI 组， 出院率高于 NNPDI 组 （均 P＜0.05）； 2 组间自动出院率差异无统计学意义 （P＞0.05）。结论 NICU 专职医生管理可能在一定程 度上改善神经外科重症患者的预后， 但在多数并发症的管理中尚未体现出明显优势， 专业化管理水平仍有待提高。

关键词: 水电解质失调, 预后, 神经外科重症监护单元, 治疗, 病死率

Abstract: Objective To explore the implementation styles on the therapeutic effects on the neurosurgical intensive care unit (NICU) patients. Methods Patients were enrolled during February 3, 2015 to February 3, 2016. The key point time was August 3, 2015 when the treatment in our NICU was fully implemented by NICU professional doctors. Based on this time point, all the enrolled patients were divided into non-NICU professional doctor implementing (NNPDI) group and NICU professional doctor implementing (NPDI) group. Thus non- NICU professional doctors and professional doctors were the leaders of diagnosis and treatment in tow groups. The length of hospital stay, complications, prognosis and other therapeutic outcomes were compared between two groups. Results The length of hospital stay was longer in NPDI group than that in NNPDI group (P＜0.05). The incidence of water-electrolyte imbalance was lower in NPDI group than that in NNPDI group (P＜0.05). There were no significant differences in the incidence of the ventilator-associated pneumonia (VAP), the hepatic and renal insufficiency, the intracranial infections and stress ulcers between the two groups (P＞0.05). The proportion of referral to other wards and fatality rate were both lower in NPDI group than those in NNPDI group (P＜0.05). And the discharge rate from NICU was higher in NPDI group than that of NNPDI group (P＜0.05). There was no significant difference in the rate of patients left hospital without treatment between the two groups (P＞0.05). Conclusion The NICU professional doctor implementing may be contribute to, at least in part, the improving of prognosis of NICU patients without obvious advantages in most complications. The level of professional management remains to be improved.

Key words: water-electrolyte imbalance, prognosis, neurosurgical intensive care unit (NICU), treatment, case fatality rate