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多学科肢体保护团队的特点及其对BEST-CLI试验结果的影响

Douglas W Jones¹, Alik Farber², David G Armstrong³

¹UMass Medical Center, Worcester, MA, USA.

Journal of vascular surgery

|August 30, 2025

概括

多学科的慢性肢体缺血 (CLTI) 团队减少了严重的截肢. 这些专门的CLTI团队改善了血管专家,足部和伤口护理之间的沟通,从而改善了患者的治疗结果.

科学领域:

血管外科
干预心脏病学
干预性放射学
足部医学
伤口护理

背景情况:

慢性肢体威胁性缺血 (CLTI) 的多学科治疗与更好的患者结果有关,包括更少的重大截肢.
在患有CLTI的患者中,最佳内血管治疗与外科治疗 (BEST- CLI) 试验提供了研究CLTI治疗模式的数据.

研究的目的:

描述BEST-CLI试验中CLTI团队的结构和组成.
检查BEST-CLI试验中CLTI团队的存在与患者结果之间的关联.

主要方法:

试验后的电子调查确定了CLTI护理提供者,并通过正式定义的CLTI团队的存在来表征中心.
分析了来自BEST- CLI试验的患者级数据,以评估CLTI团队对主要结果 (主要截肢,主要不良事件或死亡) 和次要结果 (高低截肢比率) 的影响.
对患者的人口统计,肢体阶段和再血管化的类型进行控制.

主要成果:

与没有团队的中心相比,具有CLTI团队的中心更频繁地为足疗 (32%对11%) 和伤口护理专家 (22%对8%) 提供主要职位.
71%的CLTI团队中心受访者认为团队工作的有效性"非常有效",而非团队中心的受访者则为29%.
多变量分析显示,CLTI组独立地与重大截肢风险降低相关 (HR 0. 60;P=0. 005),但没有重大不良事件或死亡.
与没有CLTI团队 (0.31;P=0.03) 的中心相比,高低截肢率显著较低.

结论:

在BEST- CLI试验中,正式定义的CLTI组与大截肢的风险降低有关.
在CLTI团队中,血管专家,足科医生和伤口护理提供者之间的沟通和协作可能有助于减少重大截肢率.

关键词:

截肢内血管疾病肢体的保存下肢绕道多学科团队

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