本文關(guān)鍵詞： 腦梗死 血栓溶解療法 入院至給予靜脈溶栓治療時(shí)間 持續(xù)質(zhì)量改進(jìn)　出處：《中國(guó)全科醫(yī)學(xué)》2017年24期 　論文類(lèi)型：期刊論文

【摘要】：目的探討持續(xù)質(zhì)量改進(jìn)(CQI)在縮短行靜脈溶栓治療的急性缺血性腦卒中(AIS)患者入院至給予靜脈溶栓治療時(shí)間(DNT)中的臨床價(jià)值,以期為改善AIS患者的臨床預(yù)后提供幫助。方法選取2010年1月—2016年6月浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院建德分院收治的符合納入標(biāo)準(zhǔn)的行靜脈溶栓治療的AIS患者88例,剔除非急診就診者9例,最終納入研究者79例。根據(jù)CQI實(shí)施與否進(jìn)行分組,即2015年1月前為改進(jìn)前組(46例),2015年4月后為改進(jìn)后組(33例)。2010年1月—2014年12月本院AIS患者平均DNT為101.2 min,高于2013年美國(guó)心臟協(xié)會(huì)/美國(guó)卒中協(xié)會(huì)關(guān)于AIS的早期管理指南要求的60 min。因此,2015年1—4月運(yùn)用CQI理念與方法管理AIS患者的診治流程,使符合靜脈溶栓治療條件的AIS患者在入急診室60 min內(nèi)接受靜脈溶栓治療。觀(guān)察時(shí)間截至患者靜脈溶栓治療后3個(gè)月,比較兩組患者的主要評(píng)價(jià)指標(biāo),包括入急診室到顱腦CT檢查時(shí)間,顱腦CT檢查到開(kāi)始靜脈溶栓治療時(shí)間,DNT,靜脈溶栓治療后24 h、7 d美國(guó)國(guó)立衛(wèi)生研究院卒中患者神經(jīng)功能缺損評(píng)分(NIHSS),靜脈溶栓治療7 d內(nèi)癥狀?lèi)夯Y狀性腦出血發(fā)生率,靜脈溶栓治療后3個(gè)月改良Rankin評(píng)分(mRS),預(yù)后良好發(fā)生率,病死率。結(jié)果為保證兩組患者在年齡、糖尿病發(fā)生率及NIHSS具有可比性,剔除部分患者,最終納入改進(jìn)前組35例患者,改進(jìn)后組20例患者。改進(jìn)后組患者顱腦CT檢查到開(kāi)始靜脈溶栓治療時(shí)間、DNT短于改進(jìn)前組(P0.05);兩組患者入急診室到顱腦CT檢查時(shí)間,靜脈溶栓治療后24 h、7 d NIHSS,靜脈溶栓治療7 d內(nèi)癥狀?lèi)夯Y狀性腦出血發(fā)生率,靜脈溶栓治療后3個(gè)月mRS,預(yù)后良好發(fā)生率,病死率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 CQI在縮短AIS患者靜脈溶栓治療DNT中的臨床價(jià)值明顯,且能帶來(lái)更好的經(jīng)濟(jì)效益和社會(huì)效益,值得在各基層醫(yī)院進(jìn)一步推廣應(yīng)用。
[Abstract]:Objective to evaluate the clinical value of continuous quality improvement (CQI) in shortening the duration of intravenous thrombolytic therapy (DNT) in patients with acute ischemic stroke (AIS). Methods from January 2010 to June 2016, 88 patients with AIS who were treated with intravenous thrombolytic therapy in Jiande Branch of the second affiliated Hospital of Zhejiang University Medical College were selected. Nine cases of non-emergency patients were excluded, and 79 cases were included in the study. According to whether the CQI was implemented or not, the patients were divided into two groups. There were 46 cases of AIS before January 2015 and 33 cases after April 2015. The average DNT of patients with AIS in our hospital from January 2010 to January 2010 was 101.2 min, which was higher than that of early management of AIS by American Heart Association / American Stroke Association. Therefore, from 2015 to April, CQI was used to manage the diagnosis and treatment process of AIS patients. Intravenous thrombolytic therapy was performed in patients with AIS within 60 min after intravenous thrombolytic therapy. The observation time was 3 months after intravenous thrombolytic therapy. The main evaluation indexes of the two groups were compared. Including the time from the emergency room to the craniocerebral CT examination, Craniocerebral CT examination showed that the time of intravenous thrombolytic therapy was DNT.The neurological impairment score of stroke patients at 24 hours and 7 days after intravenous thrombolysis was evaluated by NIHSS, and the symptoms deteriorated within 7 days after intravenous thrombolytic therapy, and the incidence of symptomatic intracerebral hemorrhage was observed. Three months after intravenous thrombolytic therapy, the modified Rankin score was improved to predict the incidence of good prognosis and mortality. Results in order to ensure the comparability of age, diabetes and NIHSS between the two groups, some of the patients were excluded, and 35 patients were included in the group before the improvement. There were 20 patients in the improved group. The time from CT examination to the beginning of intravenous thrombolytic therapy was shorter than that of the group before improvement (P0.05), and the time from the emergency room to the craniocerebral CT examination of the patients in the two groups was shorter than that before the improvement. After intravenous thrombolytic therapy for 24 hours and 7 days, NIHSS, symptom deterioration, symptomatic intracerebral hemorrhage, 3 months after intravenous thrombolytic therapy, good prognosis and mortality were compared. Conclusion the clinical value of CQI in the treatment of AIS patients with intravenous thrombolytic therapy is obvious, and it can bring better economic and social benefits.
【作者單位】： 浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院建德分院急診科;浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院建德分院神經(jīng)內(nèi)科;
【基金】：建德市科技發(fā)展計(jì)劃項(xiàng)目(2014M02)
【分類(lèi)號(hào)】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 孫玉芳;張芹;李繼梅;張擁波;;靜脈溶栓治療急性缺血性腦卒中的研究進(jìn)展[J];中國(guó)全科醫(yī)學(xué);2015年12期

2 于麗君;邱學(xué)榮;強(qiáng)家奇;王志剛;王薔;;阿替普酶靜脈溶栓聯(lián)合尤瑞克林治療急性腦梗死的療效及安全性評(píng)價(jià)[J];疑難病雜志;2015年04期

3 樓敏;;缺血性卒中患者的溶栓治療:問(wèn)題和對(duì)策[J];浙江大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2014年01期

4 ;各類(lèi)腦血管疾病診斷要點(diǎn)[J];中華神經(jīng)科雜志;1996年06期

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 戚勝;董立煥;成杰;王云龍;劉萍萍;劉艷豐;王衛(wèi)亮;張愛(ài)麗;;腦卒中后急性應(yīng)激障礙患者發(fā)生便秘的影響因素[J];中國(guó)健康心理學(xué)雜志;2017年09期

2 李新杰;喬欽增;王靜;左慧;;健康教育照護(hù)者對(duì)腦卒中后抑郁患者療效的影響[J];預(yù)防醫(yī)學(xué)情報(bào)雜志;2017年08期

3 韓林;高e，

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