持续质量改进在缩短行静脉溶栓治疗的急性缺血性脑卒中患者入院至给予静脉溶栓治疗时间中的临床价值

发布时间：2018-02-22 17:11

本文关键词： 脑梗死血栓溶解疗法入院至给予静脉溶栓治疗时间持续质量改进　出处：《中国全科医学》2017年24期 　论文类型：期刊论文

【摘要】：目的探讨持续质量改进(CQI)在缩短行静脉溶栓治疗的急性缺血性脑卒中(AIS)患者入院至给予静脉溶栓治疗时间(DNT)中的临床价值,以期为改善AIS患者的临床预后提供帮助。方法选取2010年1月—2016年6月浙江大学医学院附属第二医院建德分院收治的符合纳入标准的行静脉溶栓治疗的AIS患者88例,剔除非急诊就诊者9例,最终纳入研究者79例。根据CQI实施与否进行分组,即2015年1月前为改进前组(46例),2015年4月后为改进后组(33例)。2010年1月—2014年12月本院AIS患者平均DNT为101.2 min,高于2013年美国心脏协会/美国卒中协会关于AIS的早期管理指南要求的60 min。因此,2015年1—4月运用CQI理念与方法管理AIS患者的诊治流程,使符合静脉溶栓治疗条件的AIS患者在入急诊室60 min内接受静脉溶栓治疗。观察时间截至患者静脉溶栓治疗后3个月,比较两组患者的主要评价指标,包括入急诊室到颅脑CT检查时间,颅脑CT检查到开始静脉溶栓治疗时间,DNT,静脉溶栓治疗后24 h、7 d美国国立卫生研究院卒中患者神经功能缺损评分(NIHSS),静脉溶栓治疗7 d内症状恶化、症状性脑出血发生率,静脉溶栓治疗后3个月改良Rankin评分(mRS),预后良好发生率,病死率。结果为保证两组患者在年龄、糖尿病发生率及NIHSS具有可比性,剔除部分患者,最终纳入改进前组35例患者,改进后组20例患者。改进后组患者颅脑CT检查到开始静脉溶栓治疗时间、DNT短于改进前组(P0.05);两组患者入急诊室到颅脑CT检查时间,静脉溶栓治疗后24 h、7 d NIHSS,静脉溶栓治疗7 d内症状恶化、症状性脑出血发生率,静脉溶栓治疗后3个月mRS,预后良好发生率,病死率比较,差异无统计学意义(P0.05)。结论 CQI在缩短AIS患者静脉溶栓治疗DNT中的临床价值明显,且能带来更好的经济效益和社会效益,值得在各基层医院进一步推广应用。
[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.
【作者单位】：浙江大学医学院附属第二医院建德分院急诊科;浙江大学医学院附属第二医院建德分院神经内科;
【基金】：建德市科技发展计划项目(2014M02)
【分类号】：R743.3

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