HFMEA模式在优化首发急性缺血性脑卒中静脉溶栓救治中的应用效果  

Application effect of HFMEA model in optimizing intravenous thrombolysis for first-episode acute ischemic stroke

作　　者：夏玉婷 甄文 李家欣 霍佳佳 XIA Yuting;ZHEN Wen;LI Jiaxin;HUO Jiajia(Department of Emergency,Affiliated Hospital of Wanxi Health Vocational School,Lu’an Anhui 237000;Department of Neurology,Affiliated Hospital of Wanxi Health Vocational School,Lu’an Anhui 237000,China)

机构地区：[1]皖西卫生职业学院附属医院急诊科,安徽六安237000 [2]皖西卫生职业学院附属医院神经内科,安徽六安237000

出　　处：《临床与病理杂志》2023年第6期1190-1198,共9页Journal of Clinical and Pathological Research

摘　　要：目的:探讨医疗失效模式与效应分析(healthcare failure mode and effect analysis,HFMEA)模式在优化首发急性缺血性脑卒中(acute ischemic stroke,AIS)静脉溶栓救治中的应用效果及评价。方法:分别选取2018年6月至2020年3月、2020年4月至2022年1月皖西卫生职业学院附属医院急诊科救治的AIS患者为对照组(n=45)与观察组(n=55)。对照组采取急诊AIS常规护理流程,观察组采取HFMEA模式下的优化护理,比较2组入院-完成各环节用时、溶栓效率、治疗前后神经功能恢复情况及住院时间,并比较随访6个月后预后优良率。结果:观察组入院-完成各环节用时及住院时间均短于对照组(均P<0.05)。观察组入院-给予静脉溶栓时间(door to needle time,DNT)≤60 min达标率、血管再通率及溶栓有效率均高于对照组(均P<0.05)。观察组治疗24 h和7 d后的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、改良Rankin量表(modified Rankin Scale,mRS)评分均显著低于对照组(均P<0.05)。随访6个月,观察组预后优良率高于对照组(分别为96.36%和84.44%,P<0.05)。结论:HFMEA模式的优化护理能有效缩短首发AIS患者静脉溶栓各环节用时,提升整体溶栓效率,进而改善患者预后。Objective:To explore the effect of Healthcare Failure Mode and Effect Analysis(HFMEA)in optimizing intravenous thrombolysis for first-episode acute ischemic stroke(AIS).Methods:Patients with AIS treated in the Emergency Department of Affiliated Hospital of Wanxi Health Vocational School from June 2018 to March 2020 and from April 2020 to January 2022 were selected as a control group(n=45)and an observation group(n=55).The control group was treated with emergency AIS routine nursing process,and the observation group was treated with optimized nursing under HFMEA mode.The time of admission to completion of each link,the thrombolysis efficiency,neurological function recovery before and after treatment and hospitalization time were compared between the 2 groups,and the prognosis after 6 months of follow-up was compared.Results:The time of admission to completion of each link and hospitalization time in the observation group were shorter than those in the control group(all P<0.05).The door to needle time(DNT)≤60 min compliance rate,vascular recanalization rate,and thrombolysis efficiency in the observation group were higher than those in the control group(all P<0.05).The National Institutes of Health Stroke Scale(NIHSS)score and modified Rankin Scale(mRS)score in the observation group 24 h and 7 d after treatment were significantly lower than those in the control group(all P<0.05).After 6 months of follow-up,the excellent and good rate of prognosis in the observation group was higher than that in the control group(96.36%vs 84.44%,P<0.05).Conclusion:The optimized nursing of HFMEA model can effectively shorten the time of intravenous thrombolysis in patients with first-episode AIS,improve the overall thrombolysis efficiency and the prognosis of patients.

关 键 词：医疗失效模式与效应分析 脑卒中 静脉溶栓 入院-给予静脉溶栓时间 

分 类 号：R743.3[医药卫生—神经病学与精神病学]