發(fā)布時間：2018-02-22 17:11

  本文關鍵詞： 腦梗死 血栓溶解療法 入院至給予靜脈溶栓治療時間 持續(xù)質量改進　出處：《中國全科醫(yī)學》2017年24期 　論文類型：期刊論文

【摘要】：目的探討持續(xù)質量改進(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間(DNT)中的臨床價值,以期為改善AIS患者的臨床預后提供幫助。方法選取2010年1月—2016年6月浙江大學醫(yī)學院附屬第二醫(yī)院建德分院收治的符合納入標準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實施與否進行分組,即2015年1月前為改進前組(46例),2015年4月后為改進后組(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年美國心臟協(xié)會/美國卒中協(xié)會關于AIS的早期管理指南要求的60 min。因此,2015年1—4月運用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內接受靜脈溶栓治療。觀察時間截至患者靜脈溶栓治療后3個月,比較兩組患者的主要評價指標,包括入急診室到顱腦CT檢查時間,顱腦CT檢查到開始靜脈溶栓治療時間,DNT,靜脈溶栓治療后24 h、7 d美國國立衛(wèi)生研究院卒中患者神經功能缺損評分(NIHSS),靜脈溶栓治療7 d內癥狀惡化、癥狀性腦出血發(fā)生率,靜脈溶栓治療后3個月改良Rankin評分(mRS),預后良好發(fā)生率,病死率。結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,最終納入改進前組35例患者,改進后組20例患者。改進后組患者顱腦CT檢查到開始靜脈溶栓治療時間、DNT短于改進前組(P0.05);兩組患者入急診室到顱腦CT檢查時間,靜脈溶栓治療后24 h、7 d NIHSS,靜脈溶栓治療7 d內癥狀惡化、癥狀性腦出血發(fā)生率,靜脈溶栓治療后3個月mRS,預后良好發(fā)生率,病死率比較,差異無統(tǒng)計學意義(P0.05)。結論 CQI在縮短AIS患者靜脈溶栓治療DNT中的臨床價值明顯,且能帶來更好的經濟效益和社會效益,值得在各基層醫(yī)院進一步推廣應用。
[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】： 浙江大學醫(yī)學院附屬第二醫(yī)院建德分院急診科;浙江大學醫(yī)學院附屬第二醫(yī)院建德分院神經內科;
【基金】：建德市科技發(fā)展計劃項目(2014M02)
【分類號】：R743.3

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本文編號：1524874