ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 >

2022 , Vol. 3 >Issue 4: 354 - 359

DOI: https://doi.org/10.3761/j.issn.2096-7446.2022.04.014

质量与安全

急性缺血性卒中患者溶栓流程的优化及效果评价

  • 洪慧 ,
  • 闫丹萍 ,
  • 王钰炜 ,
  • 张瑞
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  • 310009 杭州市 浙江大学医学院附属第二医院急诊抢救室
洪慧：女,本科,主管护师,E-mail：zrjzhh@zju.edu.cn

收稿日期: 2021-06-09

  网络出版日期: 2022-07-07

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Optimization and effect evaluation of emergency procedures for patients with acute stroke

  • HONG Hui ,
  • YAN Danping ,
  • WANG Yuwei ,
  • ZHANG Rui
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Received date: 2021-06-09

  Online published: 2022-07-07

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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

本文引用格式

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 . DOI: 10.3761/j.issn.2096-7446.2022.04.014

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

参考文献

[1] Joundi RA,Saposnik G,Martino R,et al.Timing of direct enteral tube placement and outcomes after acute stroke[J]. J Stroke Cerebrovasc Dis,2019,28(12):104401.
[2] 陶静,高莲莲,刘清华,等. 追踪方法学联合失效模式与效应分析在非内分泌科胰岛素泵质量管理中的应用[J]. 中华护理杂志,2016,51(12):1417-1421.
Tao J,Gao LL,Liu QH,et al.The application of tracking methodology combined with FMEA in insulin pump safety system of patients admitted to non-diabetic divisions[J]. Chin J Nurs,2016,51(12):1417-1421.
[3] 孙娟,王清,沈小芳. 阿替普酶溶栓治疗急性缺血性脑卒中患者的集束化护理[J]. 护理学杂志,2015,30(23):23-25.
Sun J,Wang Q,Shen XF.Care bundle for patients receiving alteplase treatment for acute ischemic stroke attack[J]. J Nurs Sci,2015,30(23):23-25.
[4] Powers WJ,Rabinstein AA,Ackerson T,et al.2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke,2018,49(3):e46-e110.
[5] 陈美芳,吴月峰,黄春华. 危机管理模式结合传统外伤急救护理对急诊颅脑外伤患者的应用效果[J]. 中华全科医学,2019,17(4):693-695.
Chen MF,Wu YF,Huang CH.Application effect of crisis mana-gement mode combined with traditional trauma emergency care on patients with emergency craniocerebral trauma[J]. Chin J Gen Pract,2019:17(4):693-695.
[6] 钱细友,蔡海荣,黄秋萍,等. 优化的急诊流程在急性缺血性脑卒中患者中的应用[J]. 中国中医急症,2017,26(3):562-564.
Qian XY,Chai HR,Huang QP,et al.Application of optimized emergency procedures in patients with acute ischemic stroke[J]. Chin Emerg Tradi Chin Med,2017,26(3):562-564.
[7] 邓先锋,向莉,冯霞,等. 急性缺血性脑卒中院前院内协作的溶栓急救绿色通道构建[J]. 临床急诊杂志,2019,20(11):860-865.
Deng XF,Xiang L,Feng X,et al.Construction of a green channel for thrombolysis and first aid in the front hospital of acute ischemic stroke[J]. J Clini Emerg Med,2019,20(11):860-865.
[8] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018,51(9):666-682.
Neurology Branch of Chinese Medical Association,Cerebrovascular Disease Group of Neurology Committee of Chinese Medi-cal Association. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol,2018,51(9):666-682.
[9] 金静芬,陈水红,张茂,等. 急诊预检分级分诊标准的构建研究[J]. 中华急诊医学杂志,2016,25(4):527-531.
Jin JF,Chen SH,Zhang M,et al.Research on the construction of emergency pre-examination grading and triage standards[J]. Chin J Emerg Med,2016,25(4):527-531.
[10] 金静芬. 急诊预检分诊标准解读[J]. 中华急危重症护理杂志,2020,1(1):49-52.
Jin JF.Interpretation for emergency triage scale[J]. Chin J Emerg Crit Care Nurs,2020,1(1):49-52.
[11] Berglund A,Svensson L,Wahlgren N,et al.Face Arm Speech Time Test use in the prehospital setting,better in the ambulance than in the emergency medical communication center[J]. Cerebrovasc Dis,2014,37(3):212-216.
[12] 吴智鑫,何明丰,黎练达,等. 急诊脑卒中识别评分量表筛选价值的探讨[J]. 中国急救医学,2010,30(3):219.
Wu ZX,He MF,Li LD,et al.Discussion on the screening value of the emergency stroke recognition score scale[J]. Chin Emerg Med,2010,30(3):219.
[13] 邱晨,邱孝丰,张丽萍,等. 基于循证理念的军队环境性急症标准急救流程及检核表构建研究[J]. 中国急救复苏与灾难医学杂志,2018,13(3):217-221.
Qiu C,Qiu XF,Zhang LP,et al.Research on the construction of standard first aid procedures and checklists for military environmental emergencies based on evidence-based concepts[J]. Chin Jour of Emerg Resus and Disa Med,2018,13(3):217-221.
[14] 陈水红,王飒,方莉,等. 虚拟挂号就诊模式在急诊预检分诊中的应用[J]. 护理与康复,2016,15(5):478-480.
Chen SH,Wang S,Fang L,et al.Application of virtual registration and consultation mode in emergency pre-examination and triage[J]. J Nurs Rehabilitation,2016,15(5):478-480.
[15] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志,2015,48(4):246-257.
Chinese Medical Association Neurology Branch,Chinese Me-dical Association Neurology Branch Cerebrovascular Disease Group. Chinese acute ischemic stroke diagnosis and treatment guidelines 2014[J]. Chin J Neurol,2015,48(4):246-257.
[16] 方良玉,陈水红,吴爱青,等. 基于ABC分类法的急诊室外勤服务项目优先次序框架构建[J]. 护理与康复,2016,15(1):53-56.
Fang LY,Chen SH,Wu AQ,et al.The construction of the priority order framework of emergency outdoor service items based on ABC classification[J]. J Nurs Rehabilitation,2016, 15(1):53-56.
[17] 郭伟,李斗,彭鹏. 急性缺血性脑卒中急诊急救中国专家共识(2018)[J]. 临床急诊杂志,2018,19(6):351-359.
Guo W,Li D,Peng P.Chinese expert consensus on acute ischemic stroke emergency medicine(2018)[J]. J Clin Emerg,2018,19(6):351-359.
[18] 戴威,付睿,席春江,等. 急性缺血性卒中患者NIHSS评分与血管闭塞的相关性研究[J]. 实用医学杂志,2014,30(11):1792-1794.
Dai W,Fu R,Xi CJ,et al.Study on the correlation between NIHSS score and vascular occlusion in patients with acute ischemic stroke[J]. J Pract Med,2014,30(11):1792-1794.
[19] 李华,周军. 手机微信平台在初产妇延续性护理中的效果[J].解放军医院管理杂志,2016,23(11):1080-1082.
Li H,Zhou J.The effect of mobile phone WeChat platform in continuity nursing of primipara[J]. J PLA Hos Manage,2016, 23(11):1080-1082.
[20] 汪嘉玲,吕诗清,梁启诚,等. 导入医疗团队资源管理提升急诊多重外伤照护流程[J]. 长庚护理,2014,25(2):168-181.
Wang JL,Lü SQ,Liang QC,et al.Introducing medical team resource management to improve emergency care for multiple traumas[J]. Chang Gung Nurs,2014,25(2):168-181.
[21] 崔远航,倪圆圆,冀璇,等. 团队资源管理医疗应用进展[J]. 中华现代护理杂志,2017,23(4):589-592.
Cui YH,Ni YY,Ji X,et al.Progress in medical application of team resource management[J]. Chin J Mod Nurs,2017,23(4):589-592.
[22] 姚琳,柳清霞,王薇. 某三级甲等综合医院急诊抢救室患者收治情况分析与启示[J]. 护理学报,2018,25(18):22-26.
Yao L,Liu QX,Wang W.Comprehensive information of patient treatment in emergency room of one tertiary grade A hospital:analysis and inspiration[J]. J Nurs China,2018,25(18):22-26.
[23] 刘洪伟,史文宗,王耀辉,等. 某市综合三级甲等医院急诊抢救室患者滞留时间影响因素分析[J]. 中国急救复苏与灾害医学杂志,2021,16(1):72-74.
Liu HW,Shi WZ,Wang YH,et al.Analysis of influencing factors of patient detention time in emergency department of a comprehensive tertiary hospital in a city[J]. Chin J Emerg Resusc Disater Med,2021,16(1):72-74.
[24] Du Y,Duan H,Qiao X,et al.Effect of biglycan on apoptosis ofneurons in acute cerebral infarction in rats[J]. FASEB J,2020, 34(S1):1.
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