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缺血性脑卒中患者静脉溶栓院内流程优化研究

常红 杨莘 梁潇 孙雪莲 郭蕊 吉训明 郭秀海 宋海庆 马青峰 孙长怡   

  1. 首都医科大学宣武医院神经内科,100053 北京市(常红,宋海庆,马青峰);护理部(杨莘);急诊科(梁潇,孙雪莲,孙长怡);科研处(吉训明,郭秀海);首都医科大学护理学院(郭蕊)
  • 出版日期:2017-08-25 发布日期:2017-08-25
  • 基金资助:
    北京市科学技术委员会生物医药与生命科学创新培育研究项目 (Z151100003915088)

The comparative study before and after hospitalized optimized treatment process of intravenous thrombolysis among patients with ischemic stroke

  • Online:2017-08-25 Published:2017-08-25

摘要: 目的:优化缺血性脑卒中患者静脉溶栓院内救治流程,缩短患者到院至用药的时间(Door-to-Needle Time,DNT),提高患者院内静脉溶栓治疗时间窗内的溶栓率。方法:建立“并联诊疗”模式的静脉溶栓院内流程;比较流程优化前后患者DNT及各关键环节用时、院内时间窗内患者溶栓率及患者预后。结果:流程优化后比优化前DNT中位数缩短62 min(P<0.01);优化后院内时间窗内患者溶栓率提高了76.3%;护士接诊至急诊医生开始接诊的时间中位数缩短3 min (P<0.01);护士接诊至溶栓医生开始接诊的时间中位数缩短9 min(P<0.01);护士抽血结束至检验回报的时间中位数缩短23 min(P<0.01);护士接诊至完成CT的时间中位数缩短13 min(P<0.05);家属决策时间中位数缩短12 min(P<0.01);患者住院时间中位数缩短2 d(P<0.01)。结论:静脉溶栓院内流程优化效果显著,DNT及各关键环节用时显著缩短,院内时间窗内患者溶栓率明显提高,改善了患者预后。

Abstract: Objective: To optimize hospitalized treatment process of intravenous thrombolysis among patients with ischemic stroke, to shorten Door-to-Needle Time (DNT), and to improve the thrombolysis rate within the hospitalized time window of intravenous thrombolysis. Methods: We established a "parallel treatment" model for hospitalized treatment process of intravenous thrombolysis and used the observational and quasi-experimental research methods to compare the time from the hospital to medication (DNT), the rate of thrombolysis within the hospitalized time window, the time of key links and clinical outcomes before and after process optimizing. Results: After the process optimizing, the median DNT was 62 minutes which was shorter than that before the process optimizing (P<0.01), and the thrombolysis rate increased by 76.3% within the time window. The median time from nurse admissions to the emergency doctors admissions was shortened 3 minutes (P<0.01), and the median time from nurse admissions to thrombolysis doctors admissions was shortened 9 minutes (P<0.01). The median time from nurse taking a blood sample to test outcomes returning was shortened 23 minutes (P<0.01), and the median time from nurses admissions to CT completing was shorten 13 minutes (P<0.01). The median time of family decision time was shortened 12 minutes (P<0.01). The median time of hospital stays was shortened 2 days (P<0.01). Conclusion: The effect of hospitalized optimized treatment process of intravenous thrombolysis is obvious, and DNT time, the time of key links, and the thrombolysis rate within the hospitalized time window has been improved, and the prognosis of patients have been improved.