MDT门诊在胎盘植入性疾病管理中的作用

Role of multi-disciplinary team clinic in management of placenta accreta spectrum

摘要

目的 评价门诊多学科团队诊疗(MDT)在胎盘植入性疾病(PAS)亚专科管理中的作用和对母婴结局的影响。方法 采用回顾性队列研究分析2020-2024年本院定期产检并分娩,最终诊断为前置胎盘伴胎盘植入的140例患者,按管理方式不同分为常规组和MDT组。常规组为2020年1月-2022年11月期间实行产科一贯制管理的前置胎盘伴胎盘植入患者(n=50),MDT组为2022年12月-2024年12月期间参加胎盘植入MDT门诊,并进行亚专科管理的患者(n=90),通过管理方式的改进,对患者实行全孕期个体化精细管理,采用t检验、Kappa检验、χ²检验、Fisher精确概率法、Mann-Whitney U检验比较两组母婴结局的变化。结果 和常规组比较,MDT组PAS分级诊断的一致性显著提高(χ²=12.963,P<0.001)。MDT组母亲术中出血量(t=1.995,P=0.048)和产后24小时出血量(t=2.043,P=0.043)显著下降,MDT组的产后出血发生率(χ²=18.485,P<0.001)、异体红细胞输注率(χ²=6.718,P=0.010)、血浆输注率(χ²=4.032,P=0.045)、ICU入住率(χ²=13.594,P<0.001)均显著下降,MDT组新生儿出生后5分钟Apgar评分较常规组显著好转(Z=-8.073,P<0.001)。结论 多学科团队诊疗门诊提升了胎盘植入性疾病精准化诊疗质量,联合产科一贯制管理后有利于改善母婴结局,推动亚专科建设。

Abstract

Objective Evaluation of the role of multi-disciplinary team (MDT) diagnosis and treatment in the management of placenta accreta spectrum (PAS) in the outpatient setting and its impact on maternal and infant outcomes. Methods A retrospective cohort study was conducted to analyze 140 patients diagnosed with placenta previa and placenta accreta spectrum who underwent regular prenatal examinations and deliveries at our hospital from 2020 to 2024. The patients were divided into the conventional group and the MDT group based on different management methods. The conventional group consisted of 50 patients with placenta accreta spectrum and placenta accreta spectrum who received consistent obstetric management from January 2020 to November 2022, while the MDT group consisted of 90 patients who participated in the placenta accreta spectrum MDT clinic and received sub-specialty management from December 2022 to December 2024. Through the improvement of management methods, individualized and precise management was implemented throughout the pregnancy for the patients. t test, Kappa test, χ ² test, Fisher's exact probability method, and Mann-Whitney U test were used to compare the changes in maternal and infant outcomes between the two groups. Results Compared with the conventional group, the consistency of PAS diagnosis in the MDT group significantly improved (χ ²=12.963, P<0.001). The intraoperative blood loss during surgery (t=1.995, P=0.048) and the 24-hour postpartum blood loss (t=2.043, P=0.043) in the MDT group were significantly reduced. The postpartum hemorrhage rate (χ ²=18.485, P<0.001), the rate of allogeneic red blood cell transfusion (χ ²=6.718, P=0.010), the plasma transfusion rate (χ ²=4.032, P=0.045), and the intensive care unit admission rate (χ ²=13.594, P<0.001) in the MDT group were significantly lower. The 5-minute Apgar score of the newborns in the MDT group was significantly better than that in the conventional group (Z=-8.073, P<0.001). Conclusion The MDT clinic has improved the quality of precise diagnosis and treatment of placenta accreta spectrum. Combined with consistent obstetric management, it is beneficial to improve maternal and infant outcomes and promote the construction of sub-specialties.

关键词

胎盘植入 / 产科一贯制 / 多学科诊疗 / 母婴结局 / 亚专科管理

Key words

placenta accreta spectrum / continuity of maternity care / multi-disciplinary team / maternal and infant outcome / subspecialty management

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基金资助

常州市十四五高层次领军人才(2022CZLJ023)

南京医科大学常州医学中心项目(CMCC202410)

常州市卫生健康委青年项目(QN202374)