失效模式与效应分析在血管再通流程优化中的应用效果评价  

Application evaluation of failure mode and effect analysis in optimization of vascular recanalization process

作　　者：周秀红[1] 杜新平[1] 王宽[1] 左国兴 胡圣[1] 薛金红[1] 苑丹丹 杜姣姣[1] Zhou Xiuhong;Du Xinping;Wang Kuan;Zuo Guoxing;Hu Sheng;Xue Jinhong;Yuan Dandan;Du Jiaojiao(Department of Cardiology,the Tianjin Fifth Central Hospital,Tianjin 300450,Chin)

机构地区：[1]天津市第五中心医院心血管内科,300450

出　　处：《中华危重病急救医学》2018年第7期686-690,共5页Chinese Critical Care Medicine

基　　金：天津市滨海新区塘沽科技兴区计划项目（2005xQ11-07）

摘　　要：目的探讨失效模式与效应分析（FMEA）在ST段抬高型心肌梗死（STEMI）患者血管再通流程优化中的临床应用和效果评价。方法选择2014年1月至2015年1月就诊于天津市第五中心医院急诊科389例STEMI患者作为对照组；选择2016年1月至2017年10月就诊于天津市第五中心医院胸痛中心398例STEMI患者作为试验组。对照组采用常规急救处理方法，同时介入室执行24 h备班制以便于进行急诊血管再通治疗。试验组采用FMEA方法，即首先确定导致血管再通治疗延误的主要因素，并针对这些影响因素优化血管再通流程，从而缩短患者＂罪犯＂血管开通时间。记录两组患者就诊至球囊扩张时间（D-to-B时间）、肌钙蛋白检测时间、导管室人员到位时间、启动导管室至球囊扩张时间，术前和术后1周N末端脑钠肽前体（NT-proBNP）水平，术后1周、3个月及6个月心功能指标〔左室射血分数（LVEF）、左室短轴缩短率（FS）、左室收缩期末内径（LVESD）、左室舒张期末内径（LVEDD）〕，以及术后1个月内主要心血管不良事件发生率、住院病死率、住院时间和1年内再住院情况。结果试验组D-to-B时间（min：70.6±3.6比79.4±8.7）、肌钙蛋白检测时间（min：17.1±2.3比65.2±6.5）、导管室人员到位时间（min：28.9±9.8比52.3±12.2）及启动导管室至球囊扩张时间（min：47.3±9.3比65.1±7.2）较对照组明显缩短（均P〈0.01）。两组患者术后1周NT-proBNP水平均较术前明显降低，以试验组降低稍明显，但差异无统计学意义。试验组患者术后1周及3个月各项心功能指标与对照组比较差异也无统计学意义；但6个月LVEF、FS较对照组明显升高〔LVEF：0.622±0.054比0.584±0.076，FS：（38.1±4.3）%比（35.4±6.2）%，均P〈0.01〕，LVESD、LVEDD较对照组明显减小〔LVESD（mm）：31.2±3.8比34.7±4.2，LVEDD（mm）：49.2±5.3比52.4±5.6，均P〈0.01〕。试ObjectiveTo investigate the clinical application and effect evaluation of failure mode and effect analysis （FMEA） in the optimization of vascular recanalization in patients with ST-segment elevation myocardial infarction （STEMI）.MethodsA total of 389 STEMI patients admitted to the emergency department of the Fifth Central Hospital in Tianjin from January 2014 to January 2015 were served as the control group, and 398 STEMI patients admitted to the chest pain center of the Fifth Central Hospital in Tianjin from January 2016 to October 2017 were served as the experimental group. In the control group, routine emergency treatment was used. At the same time, the intervention room was 24-hour prepared for emergency vascular recanalization. The experimental group used FMEA. Through the usage of FMEA, the main factors those caused the delay in revascularization treatment were determined, and the revascularization process was optimized for these influencing factors, thereby shortening the ＂criminal＂ blood vessel opening time of patients. The door-to-balloon dilatation time （D-to-B time）, troponin testing time, placement time of the catheterization room, initiation of the catheterization room to balloon dilatation time, and preoperative and 1 week postoperative N-terminal pro-brain natriuretic peptide （NT-proBNP） levels, heart function parameters [left ventricular ejection fraction （LVEF）, left ventricular short axis shortening rate （FS）, left ventricular end-systolic diameter （LVESD）, and left ventricular end-diastolic diameter （LVEDD）] within 1 week, 3 months and 6 months after intervention, and the incidence of main cardiovascular adverse events within 1 month after intervention, hospital mortality, the length of hospital stay, and readmission within 1 year in the patients of two groups were recorded.ResultsD-to-B time （minutes： 70.6±3.6 vs. 79.4±8.7）, troponin testing time （minutes： 17.1±2.3 vs. 65.2±6.5）, placement time of the catheterization room （minutes： 28.9±

关 键 词：失效模式与效应分析 血管再通流程优化程序 ST段抬高型心肌梗死 不良事件 预后 

分 类 号：R542.22[医药卫生—心血管疾病]