Analyzing the multidisciplinary strategies for diagnosis and treatment of patients with burns and trauma from a management perspective
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摘要: 烧创伤患者病情复杂,常涉及多学科诊疗需求,单一学科难以满足现代医疗目标需求。多学科团队（MDT）协作诊疗作为解决这一问题的重要模式,在实际临床应用中面临发起机制缺失、流程管理粗放、价值激励缺位等挑战。该文从管理学角度,解析烧创伤患者行MDT协作诊疗与传统会诊的本质区别,探讨其从技术层面到管理创新方面的核心问题,包括以烧伤学科优势技术为着力点、依托医疗机构强势学科、以患者为中心整合学科、以管理为纽带优化流程及以绩效倾斜驱动长效运行等,旨在为烧创伤患者行MDT协作诊疗的有效实施提供参考。Abstract: Patients with burns and trauma often have complex conditions that require multidisciplinary diagnosis and treatment as a single discipline is insufficient to meet the needs of modern medical goals. Multidisciplinary team (MDT) collaborative diagnosis and treatment, as an important model for solving this problem, faces challenges such as the lack of initiation mechanisms, loose process management, and absence of value-based incentives in practical clinical applications. From a management perspective, this article analyzes the essential differences between MDT collaborative diagnosis and treatment for burn and trauma patients and traditional consultations, and explores the core issues from the technical level to management innovation, including leveraging on the advance technologies of burn discipline, relying on the strong disciplines of medical institutions, integrating disciplines centered on patients, optimizing processes with management as a link, and driving long-term operation with performance-based incentives. The aim is to provide strategic references for the effective implementation of MDT collaborative diagnosis and treatment for burn and trauma patients.
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参考文献
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图 1 多学科团队协作诊疗高压电烧伤患者腹壁破损及肠管外露伴股动静脉损伤的效果。1A.入院时外观,可见腹壁破损、肠管外露；1B.普外科医师行肠管切除术后即刻；1C.血管外科医师行人工血管置换股动脉术后即刻；1D.烧伤整形与创面修复科医师行皮瓣移植修复腹壁和腹股沟皮肤缺损术中；1E.皮瓣移植术后即刻；1F.皮瓣移植术后6周,创面愈合
图 2 多学科团队协作诊疗高压电烧伤患者右膝关节毁损伤的效果。2A.入院时,可见右膝前侧Ⅳ度烧伤；2B.清创后,可见大面积皮肤软组织缺损合并股骨远端坏死,伴开放性关节暴露；2C.术中,烧伤整形与创面修复科医师行创面覆盖；2D.游离背阔肌肌皮瓣移植术后3个月,皮瓣完全存活,感染控制良好；2E、2F.分别为伤后3年时,骨科医师行股骨搬运过程中患肢的X线片和肉眼所见外观,骨运输段向缺损区延伸；2G.伤后4年,右侧股骨正（下图）侧（上图）位的X线片显示骨骼重建完成；2H.伤后11年随访时,患者步态接近正常
图 3 多学科团队协作诊疗患者交通伤后左下肢毁损伴嗜水气单胞菌感染的效果。3A.入院时,可见左下肢碾压伤伴广泛皮肤撕脱缺损,创面中有大量脓性分泌物及坏死组织；3B.截肢术前X线片显示胫骨粉碎性骨折；3C.截肢术中去除坏死肌肉组织后可见股骨外露；3D.截肢术中；3E.截肢术后2周,残端血运良好,移植的自体皮片成活；3F.伤后3年随访时,截肢创面愈合良好
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