Effect of multidisciplinary cooperation model on perioperative nursing of chronic ulcer of diabetes mellitus patients following lower extremity trauma / 中华创伤杂志

ABSTRACT

Objective:To explore the effect of multidisciplinary collaboration（MDT）mode on perioperative nursing of chronic ulcer of diabetes mellitus patients following lower extremity trauma.Methods:A retrospective case-control study was conducted to analyze the clinical data of 122 diabetes mellitus patients combined with chronic ulcer following lower extremity trauma admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2015 to December 2019. There were 58 males and 64 females at age of 40-76 years［（56.0 ± 4.7）years］. The wounds were located at the heel in 10 patients，at the lateral ankle in 12，at the toe in 22，at the calf in 59 and at the thigh in 19. Sixty patients received MDT care（collaborative care group），and 62 patients received traditional care（traditional care group）. Visual analogue scale（VAS）and level of fasting plasma glucose were measured at days 1 and 3 postoperatively and on the day of discharge. Mental status of the patients was evaluated using self-evaluation of anxiety scale（SAS）and self-rating depression scale（SDS）after nursing. Area and depth of wounds was detected at postoperative 2 weeks and 1 month，and level of fasting glucose was measured again within 1 month after operation. The rate of amputation，incidence of debridement and direct suture rate were documented while hospitalized again at postoperative 1 month.Results:All patients were followed up for 0.5-3 months［（1.2 ± 0.7）months］. VAS was 1.0（1.0，2.0）points，1.0（0.0，1.0）points and 1.0（0.0，1.0）points in collaborative care group at days 1 and 3 postoperatively and on the day of discharge，compared to 2.0（2.0，2.3）points，2.0（2.0，2.0）points and 1.0（1.0，2.0）points in traditional care group（ P < 0.05）. Level of fasting blood glucose was（7.2 ± 0.8）mmol/L，（6.9 ± 0.8）mmol/L and（6.9 ± 0.7）mmol/L in collaborative care group on days 1 and 3 postoperatively and on the day of discharge，compared to（7.8 ± 0.8）mmol/L，（7.8 ± 0.8）mmol/L and（7.7 ± 0.9）mmol/L in traditional care group（ P < 0.05）. Scores of SAS and SDS were（8.4 ± 0.8）points and（11.2 ± 1.0）points in collaborative care group after nursing，compared to（8.7 ± 0.7）points and（12.3 ± 1.0）points in traditional care group（ P < 0.05）. Area and depth of wounds were（29.4 ± 3.9）cm 2 and（1.4 ± 0.4）cm in collaborative care group at postoprative 2 weeks，compared to（33.3 ± 3.6）cm 2 and（1.5 ± 0.5）cm in traditional care group（ P < 0.05）. Area and depth of wounds were（24.5 ± 3.8）cm 2 and（0.9 ± 0.4）cm in collaborative care group at postoprative 1 month，compared to（30.6 ± 4.8）cm 2 and（1.2 ± 0.5）cm in traditional care group（ P < 0.05）. Level of fasting blood glucose in collaborative care group was significantly lower than that in traditional care group at postoprative 1 month（ P < 0.05）. During hospital re-admission 1 month after operation，rate of amputation and incidence of re-debridement were 5%（3/60）and 7%（4/60）in collaborative care group，significantly lower than those in traditional care group［18%（11/62），22%（13/62）］（ P < 0.05），and direct repair suture rate was 88%（53/60）in collaborative care group，significantly higher than that in traditional care group［61%（38/62）］（ P < 0.05）. Conclusion:For chronic ulcer of diabetes mellitus patients following lower extremity trauma，MDT model is superior over traditional nursing for alleviated pain，controlled blood glucose，improved psychological state，promoted wound healing and reduced rate of amputation and incidence of re-debridement.