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  

Clinical Value of Continuous Quality Improvement in Shortening the DNT of Acute Ischemic Stroke Patients with Intravenous Thrombolysis

作　　者：傅晓[1] 赵西耀[2] 王力[2] 李向新[2] 刘兰芹[1] 吴慧平[1] 

机构地区：[1]浙江大学医学院附属第二医院建德分院急诊科,浙江省杭州市311600 [2]浙江大学医学院附属第二医院建德分院神经内科,浙江省杭州市311600

出　　处：《中国全科医学》2017年第24期2972-2977,共6页Chinese General Practice

基　　金：建德市科技发展计划项目(2014M02)

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(P<0.05);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(P>0.05)。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。Objective To explore the clinical value of continuous quality improvement（ CQI） in shortening the Door-to-needle time（ DNT） of acute ischemic stroke（ AIS） patients with intravenous thrombolysis（ IVT）,in order to improve the clinical prognosis of patients with AIS. Methods From January 2010 to June 2016,88 patients with AIS who were treated by IVT,met the inclusion criteria and admitted to the Second Affiliated Hospital（ Jiande Branch）,School of Medicine,Zhejiang University were enrolled. Nine non-emergency patients were excluded,and 79 patients were included in the study finally. They were grouped according to the implementation of CQI or not. That was,patients before January 2015 were divided into before improvement group（ 46 cases）,patients after April 2015 were divided into the after improvement group（ 33 cases）. From January 2010 to December 2014,the average DNT of AIS patients was 101. 2 minutes in our hospital,which was higher than the 60 minutes required by the American Heart Association/American Stroke Association guidelines in 2013. Therefore,from January to April in 2015,the processes of the diagnosis and treatment AIS patients were managed by using CQI concepts and methods,so that the AIS patients eligible for IVT were given IVT within 60 minutes of arriving in the emergency room. The observation time ended 3 months after the patient accepted intravenous thrombolysis. The main evaluation indicators of the two groups were compared,including the door-to-CT scan time,CT scan-to-needle times,DNT,score of the National Institute of Health Stroke Scale（ NIHSS） 24 hours and 7 days after IVT,the incidence of symptomatic deterioration and symptomatic intracranial hemorrhage（ ICH） within 7 days after IVT,the score of Modified Rankin Scale（ mRS） 3 months after IVT,the rates of good prognosis and case fatality. Results In order to ensure the comparability of age,the incidence of diabetes and NIHSS between the two groups＇ patients,some patients were excluded and 35 cases of

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 

分 类 号：R43-33[医药卫生—临床医学]