急性缺血性卒中院內(nèi)救治流程優(yōu)化實踐與評價
發(fā)布時間：2018-07-26 15:37
【摘要】：目的:通過文獻與相關(guān)專業(yè)網(wǎng)站回顧國內(nèi)外急性缺血性卒中院內(nèi)救治現(xiàn)狀和救治流程管理研究進展,并以流程管理理論為指導,構(gòu)建急性缺血性卒中院內(nèi)救治流程優(yōu)化方案,并對方案進行臨床驗證評價實施效果,為縮短急性缺血性卒中院內(nèi)救治時間,提高院內(nèi)救治效率提供依據(jù)。方法:采用文獻研究、現(xiàn)場觀察以及質(zhì)性訪談研究方法,總結(jié)分析急性缺血性卒中院內(nèi)救治流程現(xiàn)狀和可優(yōu)化環(huán)節(jié)。課題組參照國際急性缺血性卒中救治相關(guān)指南,以前期研究結(jié)果為基礎構(gòu)建急性缺血性卒中院內(nèi)救治流程優(yōu)化草案,并通過專家會議法對草案進行論證,最終形成急性缺血性卒中院內(nèi)救治流程優(yōu)化方案。將急性缺血性卒中救治流程優(yōu)化方案進行類實驗臨床驗證,比較流程優(yōu)化前后兩組患者院內(nèi)救治時間和救治效果,以評價急性缺血性卒中院內(nèi)救治流程優(yōu)化的可行性和實用性。結(jié)果:1、文獻回顧研究發(fā)現(xiàn)國內(nèi)急性缺血性卒中院內(nèi)救治流程管理聚焦于靜脈溶栓流程,且救治時間與國外先進水平相比差距較大。2、現(xiàn)場觀察數(shù)據(jù)分析顯示院內(nèi)救治流程各環(huán)節(jié)耗時不均衡,醫(yī)務人員專業(yè)技術(shù)仍有待提高,急性缺血性卒中患者和家屬醫(yī)療決策延遲。深入訪談12名急性缺血性卒中院內(nèi)救治醫(yī)務人員對救治流程優(yōu)化的建議,提煉出5個主題:目前救治流程仍有改進空間;患者和家屬醫(yī)療決策延遲;對配置卒中護士的需求;對信息化平臺支持的需求;對多學科合作密切性加強的需求。3、在前期現(xiàn)況研究的基礎上,初步構(gòu)建急性缺血性卒中院內(nèi)救治流程優(yōu)化草案,包括配置卒中急救護士、前移靜脈溶栓地點至CT室、開展多元化病情告知方式、建設卒中救治流程管理信息平臺等,并經(jīng)過專家會議論證可行性和科學性最終形成急性缺血性卒中院內(nèi)救治流程優(yōu)化方案。4、將院內(nèi)救治流程優(yōu)化方案進行類實驗臨床驗證,評價流程優(yōu)化實施效果。結(jié)果顯示:干預組57例患者就診至靜脈溶栓時間中位數(shù)27.5min,就診至股動脈穿刺時間中位數(shù)51min,較對照組69例患者就診至靜脈溶栓時間中位數(shù)41min,就診至股動脈穿刺時間中位數(shù)78min顯著減少,差異均有統(tǒng)計學意義(P0.05)。流程環(huán)節(jié)中就診至�？漆t(yī)生接診時間中位數(shù)1min、就診至開始CT時間中位數(shù)13min、開始CT至靜脈溶栓用藥時間中位數(shù)17min、靜脈溶栓用藥至股動脈穿刺時間中位數(shù)24min均較優(yōu)化前減少,且差異均有統(tǒng)計學意義(P0.05)。兩組患者治療前、治療后24h和治療后一周NIHSS評分無統(tǒng)計學差異(P0.05),但進一步分析顯示兩組治療后一周與治療后24小時差值的差異以及治療后24h與治療前NIHSS評分差值的差異均具有統(tǒng)計意義(P0.05),表明流程優(yōu)化后急性缺血性卒中患者治療24h、治療后一周救治效果優(yōu)于流程優(yōu)化前。結(jié)論:1、急性缺血性卒中院內(nèi)救治流程優(yōu)化后有效縮短了院內(nèi)救治時間,就診至靜脈溶栓用藥、就診至股動脈穿刺、就診至開始CT、開始CT至靜脈溶栓用藥、靜脈溶栓用藥至股動脈穿刺時間均較優(yōu)化前減少,差異均具有統(tǒng)計學意義(P0.05)。2、急性缺血性卒中院內(nèi)救治流程優(yōu)化后能夠改善患者良好預后,提高救治效果。3、將靜脈溶栓地點前移至CT室,極大簡化了院內(nèi)救治流程,進一步縮短開始CT至靜脈溶栓用藥時間,使院內(nèi)救治時間與國際先進水平接軌。4、卒中急救護士早期全程參與靜脈溶栓流程,有效縮短就診至靜脈溶栓用藥時間,提高院內(nèi)救治效率。
[Abstract]:Objective: To review the current status of treatment and treatment process management of acute ischemic stroke at home and abroad by literature and related professional websites, and to construct an optimization scheme for acute ischemic stroke hospital treatment process with the guidance of process management theory, and to carry out clinical evaluation of the scheme in order to shorten the acute ischemic stroke. Methods: literature study, field observation and qualitative interview study methods were used to summarize and analyze the status and optimization of hospital treatment process in acute ischemic stroke. The draft of hospital treatment process of acute ischemic stroke was optimized, and the draft was proved by expert meeting method. Finally, the optimization scheme of hospital treatment process in acute ischemic stroke was formed. The optimization scheme of acute ischemic stroke treatment process was tested by class experiment, and the treatment time and rescue of two groups of patients were compared before and after the flow optimization. The treatment effect was used to evaluate the feasibility and practicability of the optimization of the hospital treatment process in acute ischemic stroke. Results: 1. The literature review found that the treatment process management of acute ischemic stroke in China focused on the venous thrombolytic flow, and the treatment time was larger than the foreign advanced level of.2. The field observation data analysis showed that the hospital rescue was saved in the hospital. Each link of the treatment process is not balanced, the medical personnel's professional technology still needs to be improved, the acute ischemic stroke patients and their family members' medical decision is delayed. 12 suggestions on the optimization of the medical treatment process in the hospital for acute ischemic stroke are discussed, and 5 themes are extracted: the patient and family doctor still have room for improvement. The demand for apoplexy nurses; demand for apoplexy nurses; demand for information platform support; demand for the close cooperation of multidisciplinary cooperation.3. On the basis of early current situation study, preliminary construction of acute ischemic stroke hospital treatment process optimization draft, including apoplexy emergency nurse, thrombolytic location of anterior vein to CT room, development According to the way of informing the condition of the disease, building the information platform of the stroke treatment process management and so on, and through the expert meeting to demonstrate the feasibility and scientificalness of the hospital, the optimization scheme of the hospital treatment process for acute ischemic stroke was finally formed.4, and the hospital treatment process optimization scheme was tested by the class experiment, and the effect of the process optimization was evaluated. The results showed that the intervention group was the intervention group. The median of 57 cases was 27.5min, the median time of the femoral artery puncture time was 51min, and the median of 69 patients in the control group was 41min, and the median 78min of the femoral artery puncture time was significantly reduced, the difference was statistically significant (P0.05). The median time of time was 1min, the median of CT time was 13min, the median time of CT to venous thrombolysis was 17min, the median of intravenous thrombolysis to the median of femoral artery puncture time was less than that before the optimization, and the difference was statistically significant (P0.05). Before treatment, there was no statistical difference between the two groups of 24h and the one week after treatment. The difference (P0.05), but further analysis showed that the difference of the difference between two groups after treatment and 24 hours after treatment and the difference between 24h and NIHSS score after treatment were statistically significant (P0.05), indicating that after the process optimization, the acute ischemic stroke patients were treated with 24h, and the treatment effect of one week after treatment was better than that before the process optimization. Conclusion: 1, urgent. After optimizing the hospital treatment process of sexual ischemic stroke, the hospital treatment time was effectively shortened, the treatment of intravenous thrombolytic therapy, the femoral artery puncture, the beginning of the CT, the CT to intravenous thrombolytic therapy, the intravenous thrombolytic therapy to femoral artery puncture time decreased, the difference was statistically significant (P0.05).2, acute ischemic stroke. After optimizing the treatment process of stroke hospital, the patient's good prognosis can be improved, the treatment effect is improved.3, the thrombolytic location of the vein is moved forward to the CT room, which greatly simplifies the hospital treatment process, further shortens the time of starting CT to intravenous thrombolysis, makes the hospital treatment time with the international advanced water level, and participates in the vein in the early stage of the stroke first aid nurse. The thrombolytic process can effectively shorten the time for treatment of intravenous thrombolysis and improve the efficiency of in-hospital treatment.
【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
本文編號：2146479
[Abstract]:Objective: To review the current status of treatment and treatment process management of acute ischemic stroke at home and abroad by literature and related professional websites, and to construct an optimization scheme for acute ischemic stroke hospital treatment process with the guidance of process management theory, and to carry out clinical evaluation of the scheme in order to shorten the acute ischemic stroke. Methods: literature study, field observation and qualitative interview study methods were used to summarize and analyze the status and optimization of hospital treatment process in acute ischemic stroke. The draft of hospital treatment process of acute ischemic stroke was optimized, and the draft was proved by expert meeting method. Finally, the optimization scheme of hospital treatment process in acute ischemic stroke was formed. The optimization scheme of acute ischemic stroke treatment process was tested by class experiment, and the treatment time and rescue of two groups of patients were compared before and after the flow optimization. The treatment effect was used to evaluate the feasibility and practicability of the optimization of the hospital treatment process in acute ischemic stroke. Results: 1. The literature review found that the treatment process management of acute ischemic stroke in China focused on the venous thrombolytic flow, and the treatment time was larger than the foreign advanced level of.2. The field observation data analysis showed that the hospital rescue was saved in the hospital. Each link of the treatment process is not balanced, the medical personnel's professional technology still needs to be improved, the acute ischemic stroke patients and their family members' medical decision is delayed. 12 suggestions on the optimization of the medical treatment process in the hospital for acute ischemic stroke are discussed, and 5 themes are extracted: the patient and family doctor still have room for improvement. The demand for apoplexy nurses; demand for apoplexy nurses; demand for information platform support; demand for the close cooperation of multidisciplinary cooperation.3. On the basis of early current situation study, preliminary construction of acute ischemic stroke hospital treatment process optimization draft, including apoplexy emergency nurse, thrombolytic location of anterior vein to CT room, development According to the way of informing the condition of the disease, building the information platform of the stroke treatment process management and so on, and through the expert meeting to demonstrate the feasibility and scientificalness of the hospital, the optimization scheme of the hospital treatment process for acute ischemic stroke was finally formed.4, and the hospital treatment process optimization scheme was tested by the class experiment, and the effect of the process optimization was evaluated. The results showed that the intervention group was the intervention group. The median of 57 cases was 27.5min, the median time of the femoral artery puncture time was 51min, and the median of 69 patients in the control group was 41min, and the median 78min of the femoral artery puncture time was significantly reduced, the difference was statistically significant (P0.05). The median time of time was 1min, the median of CT time was 13min, the median time of CT to venous thrombolysis was 17min, the median of intravenous thrombolysis to the median of femoral artery puncture time was less than that before the optimization, and the difference was statistically significant (P0.05). Before treatment, there was no statistical difference between the two groups of 24h and the one week after treatment. The difference (P0.05), but further analysis showed that the difference of the difference between two groups after treatment and 24 hours after treatment and the difference between 24h and NIHSS score after treatment were statistically significant (P0.05), indicating that after the process optimization, the acute ischemic stroke patients were treated with 24h, and the treatment effect of one week after treatment was better than that before the process optimization. Conclusion: 1, urgent. After optimizing the hospital treatment process of sexual ischemic stroke, the hospital treatment time was effectively shortened, the treatment of intravenous thrombolytic therapy, the femoral artery puncture, the beginning of the CT, the CT to intravenous thrombolytic therapy, the intravenous thrombolytic therapy to femoral artery puncture time decreased, the difference was statistically significant (P0.05).2, acute ischemic stroke. After optimizing the treatment process of stroke hospital, the patient's good prognosis can be improved, the treatment effect is improved.3, the thrombolytic location of the vein is moved forward to the CT room, which greatly simplifies the hospital treatment process, further shortens the time of starting CT to intravenous thrombolysis, makes the hospital treatment time with the international advanced water level, and participates in the vein in the early stage of the stroke first aid nurse. The thrombolytic process can effectively shorten the time for treatment of intravenous thrombolysis and improve the efficiency of in-hospital treatment.
【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
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