An Analysis of the Efficacy of Geriatric Interdisciplinary Team Services for Elderly Patients with Multimorbidity with Malnutrition
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摘要:
目的 探索老年多学科团队（geriatric interdisciplinary team，GIT）服务对共病伴营养不良老年患者的疗效分析。 方法 选取伴DM、COPD或CHF的共病伴营养不良的老年患者109例，随机分为对照组53例及观察组56例。对照组给予常规模式管理共病及营养不良，观察组采用GIT服务模式管理共病及营养不良。分别在干预前及干预3个月后评价两组老年患者的疾病、营养状况及生活质量的转归。（1）对2组中伴DM患者检测HbA1c，对伴COPD或CHF患者观察并记录病情加重的情况；（2）对2组患者均进行营养相关指标（TP、ALB、Hb）检测及Barthel 指数评估。 结果 （1）2组中伴DM的患者干预后较干预前HbA1c降低（P < 0.001），其中观察组较对照组更显著（P < 0.001）；（2）2组中伴COPD患者干预后AECOPE发作人数，观察组少于对照组（P < 0.05）；（3）2组中CHF患者干预后CHF急性加重人数，观察组少于对照组（P < 0.05）；（4）2组患者TP、ALB、Hb及Barthel 指数评分与干预前相比均有上升，其中观察组相对于对照组上升更为显著（P < 0.05）。 结论 老年多学科团队服务在共病伴营养不良老年患者的干预中具有良好效果，提升了患者生活质量，同时也为临床治疗共病伴营养不良老年患者提供指导。 Abstract:Objective An analysis exploring the efficacy of the geriatric interdisciplinary team （GIT） service for elderly patients with multimorbidity and malnutrition. Methods A total of 109 elderly patients with multimorbidity such as DM, COPD or CHF and malnutrition were randomly divided into the control group of 53 cases and the observation group of 56 cases.The control group received routine management of multimorbidity and malnutrition, while the observation group used the GIT service model to manage multimorbidity and malnutrition.The disease, nutritional status, and quality of life outcomes of the two groups of elderly patients were evaluated before and 3 months after the intervention.（1） HbA1c was detected in patients with DM in both groups, and the aggravation of patients with COPD or CHF was observed and recorded. （2）Nutrition-related indicators （Tp, ALB and Hb） and Barthel index were evaluated in both groups. Results （1） The HbA1c of patients with DM in the two groups decreased after intervention （P < 0.001）, and the decrease in the observation group was more significant than that in the control group （P < 0.001）. （2） The number of AECOPEs in patients with COPD in the two groups decreased, and the observation group was less than the control group （P < 0.05）. （3） The number of CHF acute exacerbations in patients with CHF in the two groups decreased and the observation group was fewer than the control group （ P <0.05 ）. （4） The TP, ALB, Hb and Barthel index scores of the two groups increased compared with those before intervention, and the observation group increased more significantly than the control group （P < 0.05 ） . Conclusion The geriatric interdisciplinary team service for the elderly has a good effect in the intervention of elderly patients with multimorbidity and malnutrition, improves the quality of life of patients, and also provides guidance for the clinical treatment of elderly patients with multimorbidity and malnutrition. -
Key words:
- Geriatric interdisciplinary team services /
- Multimorbidity /
- Malnutrition
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表 1 2组糖尿病、慢性阻塞性肺疾病急性加重及慢性心衰分布情况[n（%）]
Table 1. Distribution of DM，COPD and CHF between the two groups [n（%）]
组别 DM AECOPD CHF 观察组（n=56）
对照组（n=53）
χ2
P21（37.5）
19（35.8）
0.032
0.85822（39.3）
20（37.7）
0.028
0.86821（37.5）
23（43.4）
0.393
0.532
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表 2 2组糖化血红蛋白蛋白比较[M（P25，P75）%]
Table 2. Comparison of HbA1c between the two groups[M（P25，P75）%]
组别 例数 干预前 干预后 Z P 观察组（n=56）
对照组（n=53）
Z
P21
198.90（8.30，9.20）
8.60（8.40，9.20）
−0.104
0.9177.10（6.70，7.60）**
8.00（8.00，8.40）
−3.773
0.000−4.019
−3.7680.000
0.000与干预后对照组比较，*P < 0.05。
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表 3 2组慢性阻塞性肺疾病急性加重发作情况比较[n（%）]
Table 3. Comparison of COPD attacks between the two groups[n（%）]
组别COPD 例数 AECOPD发作人数 观察组（n=56）
对照组（n=53）
干预后χ2
干预后P22
203（13.6）*
9（45）
5.050
0.025与干预后对照组比较，*P < 0.05。
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表 4 2组慢性心衰加重情况比较[n（%）]
Table 4. Comparison of CHF exacerbation between the two groups[n（%）]
组别CHF 例数 CHF急性加重人数 观察组（n=56）
对照组（n=53）
干预后χ2
干预后P21
233（14.3）*
10（43.5）
4.494
0.034与干预后对照组比较，*P < 0.05。
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表 5 2组干预前后总蛋白实验室指标比较[M（P25，P75），g/L]（1）
Table 5. Comparison of TP laboratory indicators before and after intervention in the two groups[M（P25，P75），g/L]（1）
组别 干预前 干预后 Z P 观察组（n=56）
对照组（n=53）
Z
P51.8（50.15，52.78）
51.30（50.30，52.95）
−0.274
0.78464.15（62.53，66.75）**
62.30（59.30，64.10）
−4.112
0.000−6.510
−6.3340.000
0.000与干预后对照组比较，**P < 0.001。
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表 6 2组干预前后日常生活能力评分（Barthel 指数）比较[M（P25，P75）%]
Table 6. Comparison of daily living ability scores before and after intervention in the two groups（Barthel Index）[M（P25，P75）%]
组别 干预前 干预后 Z P 观察组（n=56）
对照组（n=53）
Z
P60.00（50.00，60.00）
60.00（55.00，60.00）
−0.577
0.56475.00（70.00，80.00）*
70.00（62.50，75.00）
−1.990
0.047−6.566
−6.3880.000
0.000与干预后对照组比较，*P < 0.05。
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表 5 2组干预前后白蛋白实验室指标比较[（$\bar x \pm s $），g/L]（2）
Table 5. Comparison of ALB laboratory indicators before and after intervention in the two groups[（$\bar x \pm s $），g/L]（2）
组别 干预前 干预后 t P 观察组（n=56）
对照组（n=53）
t
P30.06±2.07
29.84±2.26
0.529
0.59837.02±1.57*
36.24±2.42
2.007
0.047−20.055
−14.0650.000
0.000与干预后对照组比较，*P < 0.05。
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表 5 2组干预前后血红蛋白实验室指标比较[M（P25，P75），g/L]（3）
Table 5. Comparison of Hb laboratory indicators before and after intervention in the two groups[M（P25，P75），g/L]（3）
组别 干预前 干预后 Z P 观察组（n=56）
对照组（n=53）
Z
P99.00（95.00，104.75）
98.00（95.00，107.50）
−0.793
0.428115.00（110.00，119.75）*
110.0（106.00，118.00）
−2.205
0.027−6.455
−6.3410.000
0.000与干预后对照组比较，*P < 0.05。
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