优化急性心肌梗死患者急救护理流程的实践

The practice of optimizing the emergency nursing process of patients with acute myocardial infarction

目的探讨优化急救护理流程在缩短急性ST段抬高型心肌梗死(ST-segment elevationmyocardial infarction,STEMI)患者首次医疗接触后至球囊扩张时间中的实践。方法选取2018年7月—2019年9月急诊入院并行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性STEMI患者为试验组,2017年4月—2018年6月的患者为对照组。试验组采用优化急救护理流程,对照组采用常规急救护理流程。比较两组急诊救治各环节时间节点,包括首次医疗接触(FMC)到首份心电图完成时间、首份心电图完成到双抗药物服用时间、双抗药物服用到激活导管室时间、激活导管室到出抢救室时间、抢救室滞留时间及首次医疗接触后至球囊扩张时间,并比较两组患者、医生对护理满意度及并发症发生率。结果共纳入73例急性STEMI患者,试验组38例,对照组35例,两组一般资料比较,差异无统计学意义(P>0.05)。两组除激活导管室到出抢救室时间差异无统计学意义(P>0.05)外,试验组从首次医疗接触开始到首份心电图完成时间、首份心电图完成到双抗药物服用时间、双抗药物服用到激活导管室时间、抢救室滞留时间及首次医疗接触后至球囊扩张时间节点较对照组均明显缩短,差异有统计学意义(P<0.001);且试验组患者及医生对护理满意度均明显提高,并发症发生率较对照组降低,差异有统计学意义(P<0.05)。结论将优化急救护理流程方法应用于急性STEMI患者抢救中,能明显缩短患者首次医疗接触后至球囊扩张时间,从而达到心肌再灌注、改善患者预后、为急救护理提供指引的目的。

Objective To explore the application and practice of optimizing the emergency nursing process in shortening the time from the first medical contact(FMC)to balloon dilatation(FMC-to-B)in patients with acute STsegment elevation myocardial infarction(STEMI).Methods Acute STEMI patients who were admitted to the emergency department and underwent percutaneous coronary intervention(PCI)from July 2018 to September 2019 were selected as the experimental group,and patients from April 2017 to June 2018 were selected as the control group.The experimental group adopted optimized emergency nursing care procedures,and the control group adopted conventional emergency nursing procedures.Compared the length of each link of emergency treatment between the two groups of patients,including the time from FMC to the completion of the first electrocardiogram,the time from the completion of the first electrocardiogram to the administration of the double-antibody drug,the time from administration of the double-antibody drug to the activation of the catheterization laboratory,and the time from the activation of the time to the exit of the rescue room,length of stay in the rescue room and FMC-to-B time,and compared the patient satisfaction,doctor satisfaction and complication rate were compared.Results A total of 73 patients with acute STEMI were included,38 in the experimental group and 35 in the control group.There was no statistically significant difference in general data between the two groups(P>0.05).There was no statistically significant difference in the time from the activation of the catheterization laboratory to the exit of the rescue room(P>0.05)between the two groups of patients.The time from FMC to the completion of the first electrocardiogram,the time from the completion of the first electrocardiogram to the administration of the dual antibody drug,the time from administration of the double-antibody drug to the activation of the catheterization laboratory,the length of stay in the rescue room and the FMC-to-B time in the experimental group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.01).And the satisfaction of patients and doctors in the experimental group was significantly improved.The complication rate was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Applying optimized emergency nursing care procedures to the patients with acute STEMI can significantly shorten the patient’s FMC-to-B time,thereby achieving myocardial reperfusion,improving patient prognosis,and providing guidelines for emergency care.