急性缺血性卒中患者溶栓流程的优化及效果评价

doi:10.3761/j.issn.2096-7446.2022.04.014

摘要/Abstract

摘要： 目的探讨急性缺血性卒中患者溶栓流程的优化方法及应用效果。方法依据急诊相关处置流程,优化急性缺血性卒中患者溶栓流程,相关科室将优化卒中流程应用于临床工作。便利选取2020年10月—2021年3月,浙江省某三级甲等综合医院急诊入院行静脉溶栓治疗的急性缺血性卒中患者为试验组,2020年4月—9月急诊入院行静脉溶栓治疗的急性缺血性卒中患者为对照组。试验组采用优化卒中流程,包括快速识别并高效预检分诊、专区专团队管理、物品环绕式“三定”管理、最高外勤等级和溶栓空间前移。收集并比较两组各救治环节耗时、静脉溶栓前后美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分。结果该研究共纳入137例急性缺血性卒中患者,试验组65例,对照组69例。试验组急诊入院到完成血标本送检耗时6.0（5.0,8.0） min,低于对照组6.0（5.5,10.5） min;试验组急诊室滞留时间8.0（6.0,9.0） min,低于对照组11.0（9.0,14.0） min;试验组入院至开始溶栓耗时41.0（29.5,50.0） min,低于对照组55.0（41.5,70.5） min。差异均具有统计学意义（P<0.05）。两组静脉溶栓前后NIHSS评分比较,差异无统计学意义（P>0.05）。结论采用优化后的急性缺血性卒中流程,有助于缩短患者入院至溶栓治疗的时间,以及急诊滞留时间。

关键词: 急性脑卒中, 血栓溶解疗法, 急救流程, 病人转送, 团队资源管理, 急症护理

Abstract: Objective To explore the optimization method and application effect of thrombolytic process in patients with acute ischemic stroke. Methods According to the emergency treatment process,optimize the thrombolysis process for patients with acute ischemic stroke. The relevant departments applied the optimized stroke process to clinical work. Patients with acute ischemic stroke who were admitted to the emergency department of a tertiary general hospital in Zhejiang Province for intravenous thrombolysis from October 2020 to March 2021 were selected as the observation group. Patients with acute ischemic stroke treated with thrombolysis from April 2020 to September 2020 were the control group. The observation group adopted an optimized stroke process,including rapid identification and efficient pre-examination and triage,special area and team management,item-surrounding "three determinations" management,the highest field level,and the forward movement of thrombolysis space. The time-consuming of each treatment link and the National Institutes of Health Stroke Scale（NIHSS） scores before and after intravenous thrombolysis were collected and compared between the two groups. Results A total of 137 patients with acute ischemic stroke were included in this study,65 in the observation group and 69 in the control group. The observation group took 6.0（5.0,8.0） minutes from emergency admission to the completion of blood specimen submission,which was lower than that of the control group by 6.0（5.5,10.5） minutes;the observation group's emergency room stay time was 8.0（6.0,9.0） minutes,lower than the control group which was 11.0（9.0,14.0） minutes;the observation group took 41.0（29.5,50.0） minutes from admission to the start of thrombolysis,lower than the control group which was 55.0（41.5,70.5） minutes. The differences were all statistically significant（P< 0.05）. There was no significant difference in NIHSS scores between the two groups before and after intravenous thrombolysis（P> 0.05）. Conclusion The use of an optimized acute ischemic stroke process can help reduce the time from hospital admission to thrombolytic therapy,as well as the time spent in the emergency department.

Key words: Acute Stroke, Thrombolytic Therapy, Emergency Procedures, Transportation of Patients, Team Resource Management, Emergency Nursing

洪慧, 闫丹萍, 王钰炜, 张瑞. 急性缺血性卒中患者溶栓流程的优化及效果评价[J]. 中华急危重症护理杂志, 2022, 3(4): 354-359.

HONG Hui, YAN Danping, WANG Yuwei, ZHANG Rui. Optimization and effect evaluation of emergency procedures for patients with acute stroke[J]. Chinese Journal of Emergency and Critical Care Nursing, 2022, 3(4): 354-359.

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