北京市某三甲医院急性缺血性卒中患者血管内治疗院内延迟干预研究  

Interventional study of endovascular treatment of in-hospital delay in patients with acute ischemic stroke in a tertiary hospital in Beijing

作　　者：李洋[1] 高丹丹[1] 赵文博[2] 段建钢[2] 吉训明[3] 

机构地区：[1]首都医科大学卫生管理与教育学院,北京100069 [2]首都医科大学宣武医院神经内科 [3]首都医科大学宣武医院科研处

出　　处：《中国脑血管病杂志》2018年第1期21-25,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：教育部长江学者奖励计划(T2014251)

摘　　要：目的通过对北京市某三甲医院急性缺血性卒中患者血管内治疗院内延迟现状进行调查,分析院内延迟产生的环节,并通过干预缩短院内延迟时间。方法 2016年8月至2017年7月前瞻性收集首都医科大学宣武医院经血管内治疗并符合纳入标准的缺血性卒中患者98例,按照干预前后将患者分为干预前(2016年8月至2017年1月)44例和干预后(2017年2月至2017年7月)54例两个时期,自行设计调查表,调查内容包括患者基本信息、临床特征以及院内救治流程的关键时间点,通过价值流程图分析存在延误的环节,并给予针对性的干预措施以缩短院内延迟时间。结果 (1)院内延迟存在的主要环节为医师评估、病情告知和签署知情同意书以及术前准备等。(2)干预效果显著,干预前后院内总流程时间中位数分别为138.0(118.5,188.8)min和93.5(80.0,114.0)min,差异有统计学意义(Z=5.929,P<0.01)。与干预前相比,干预后的评估检查时间、影像学检查时间、术前准备时间以及股动脉穿刺时间更短[16.5(10.0,27.2)min比35.0(18.2,51.8)min;10.0(9.0,11.0)min比12.5(10.0,23.8)min;48.0(30.0,67.5)min比60.5(45.5,90.8)min;15.0(12.0,18.2)min比21.0(13.0,33.0)min,Z值分别为4.150、3.685、2.801、2.852,均P<0.05]。结论缺血性卒中患者血管内治疗院内流程存在严重延迟,通过不断改进院内流程,建立平行诊疗模式,加强卒中团队人员的培训,完善信息系统平台对接等措施,可以明显缩短院内时间。Objectives To analyze the links of the in-hospital delay by investigating the status of inhospital delay in patients with acute ischemic stroke in a tertiary hospital in Beijing and to shorten the inhospital delay by intervention. Methods From August 2016 to July 2017,98 patients with ischemic stroke treated by endovascular therapy and met the inclusion criteria in the Xuanwu Hospital,Capital Medical University were collected prospectively. According to before and after intervention,the patients were divided into before intervention（ from August 2016 to January 2017,n = 44） and after intervention（ from February to July 2017,n = 54）. The questionnaire was designed by the authors. The survey included the basic information of patients,clinical features,and key time point of hospital treatment process. The delay links were analyzed through the value flow diagram,and the targeted interventions were given to shorten the time of in-hospital delay. Results（ 1） The main links of the presence of in-hospital delay are physician evaluation,disease notification,signing of the informed consent,and preoperative preparation.（ 2） The intervention effect was significant. The median total nosocomial process time before and after intervention were 138. 0（ 118. 5,188. 8） min and 93. 5（ 80. 0,114. 0） min respectively. There was significant difference（ Z = 5. 929,P 0. 01）. Compared with before intervention,the time of examination,imaging examination,preoperative preparation and femoral artery puncture were shorter（ 16. 5 [10. 0,27. 2] min vs. 35. 0[18. 2,51. 8]min; 10. 0 [9. 0,11. 0]min vs. 12. 5 [10. 0,23. 8]min; 48. 0 [30. 0,67. 5]min vs. 60. 5[45. 5,90. 8]min; 15. 0 [12. 0,18. 2]min vs. 21. 0 [13. 0,33. 0]min,Z = 4. 150,3. 685,2. 801,and2. 852,respectively; all P 0. 05）. Conclusions The nosocomial process of endovascular treatment in patients with ischemic stroke is seriously delayed. Through continuous improvement of the nosocomial process,setting up a parallel treatment modality,strengthening the st

关 键 词：缺血性卒中 血管内治疗 院内延迟 干预评价 

分 类 号：R743.3[医药卫生—神经病学与精神病学]