肺栓塞快速反应团队模式对急性肺栓塞患者诊疗质量和临床结局的影响  

Effects of pulmonary embolism response team on the quality of care and clinical outcomes in patients with acute pulmonary embolism

作　　者：梁颖[1] 王晓[2] 林运[2] 左惠娟[3] 缪黄泰[2] 聂绍平[2] Liang Ying;Wang Xiao;Lin Yun;Zuo Huijuan;Miu Huangtai;Nie Shaoping(Emergency&Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Center for Coronary Artery Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Center for Clinical and Epidemiological Research,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院急诊危重症中心,北京100029 [2]首都医科大学附属北京安贞医院冠心病中心,北京100029 [3]首都医科大学附属北京安贞医院、北京市心肺血管疾病研究所临床与流行病研究中心,北京100029

出　　处：《中华心血管病杂志》2024年第7期806-813,共8页Chinese Journal of Cardiology

基　　金：国家重点研发计划(2020YFC2004800,2022YFC2505600);北京市科技新星(Z201100006820087)。

摘　　要：目的:评估肺栓塞快速反应团队(PERT)模式实施对急性肺栓塞患者诊疗质量和临床结局的影响。方法:本研究为单中心回顾性队列研究。入选2016年7月5日至2018年7月4日在首都医科大学附属北京安贞医院就诊的急性肺栓塞患者,其中将2016年7月5日至2017年7月4日(PERT模式实施前)接受传统治疗的急性肺栓塞患者归为PERT干预前组,2017年7月5日至2018年7月4日启动PERT模式救治的急性肺栓塞患者为PERT干预后组。通过电子病历系统收集患者诊疗信息,对比两组诊疗质量[就诊到住院时间、住院到开始抗凝时间、就诊到明确诊断时间、总住院时间、住重症监护室(ICU)时间、住院费用]和住院期间临床结局(住院死亡率以及出血发生率)。结果:共纳入210例急性肺栓塞患者,年龄(63.3±13.7)岁,女性102例(48.6%)。PERT干预前组108例,PERT干预后组102例。(1)诊疗质量:两组就诊到明确诊断的时间分布情况差异有统计学意义( P=0.002),其中,PERT干预后组中<24 h完成诊断者占比比PERT干预前组高[80.4%(45/56)比50.0%(34/68), P<0.001];就诊到住院时间比PERT干预前组短[180.0(60.0,645.0)min比900.0(298.0,1 806.5)min, P<0.001],总住院时间比PERT干预前组少[12(10,14)d比14(11,16)d, P=0.001];住院到开始抗凝治疗的时间、住ICU时间、住院费用两组差异均无统计学意义( P均>0.05)。(2)住院期间临床结局:两组住院期间出血发生率和死亡率差异均无统计学意义( P均>0.05)。 结论:PERT治疗模式提高了急性肺栓塞患者的诊治效率,明显缩短了总住院时间,但对临床结局的影响仍需进一步研究。ObjectiveTo evaluate the effects of pulmonary embolism response team(PERT)on the quality of care and clinical outcomes in patients with acute pulmonary embolism.MethodsThis was a single-center retrospective cohort study.Patients with acute pulmonary embolism treated in Beijing Anzhen Hospital Affiliated to Capital Medical University from July 5,2016 to July 4,2018 were enrolled.Patients with acute pulmonary embolism who had traditional care from July 5,2016 to July 4,2017(before the implementation of PERT)were classified as PERT pre-intervention group.Patients with acute pulmonary embolism who started PERT care from July 5,2017 to July 4,2018 were divided into the PERT intervention group.The diagnosis and treatment information of patients was collected through the electronic medical record system,and the quality of care(time from visit to hospitalization,time from hospitalization to anticoagulation initiation,time from visit to definitive diagnosis,total hospital stay,time in intensive care unit(ICU),hospitalization cost)and clinical outcomes(in-hospital mortality and incidence of bleeding)were compared between the two groups.ResultsA total of 210 patients with acute pulmonary embolism,aged(63.3±13.7)years old,with 102(48.6%)female patients were included.There were 108 cases in PERT pre-intervention group and 102 cases in PERT intervention group.(1)Quality of diagnosis and treatment:there was a statistical significance between the two groups in the distribution of time from diagnosis to definitive diagnosis(P=0.002).Among them,the rate of completion of diagnosis within 24 hours after PERT intervention was higher than that before PERT intervention(80.4%(45/56)vs.50.0%(34/68),P<0.001).The time from treatment to hospitalization was shorter than that before PERT intervention(180.0(60.0,645.0)min vs.900.0(298.0,1806.5)min,P<0.001).The total length of hospital stay was less than that before PERT intervention(12(10,14)d vs.14(11,16)d,P=0.001).There was no statistical significance in the time from hospitalization to ant

关 键 词：肺栓塞 多学科 肺栓塞快速反应团队 诊疗效率 

分 类 号：R563.5[医药卫生—呼吸系统]