急诊诊治流程在急性脑梗死患者超早期溶栓护理中的应用

Application of Emergency Diagnosis and Treatment Procedure in Ultra-early Nursing of Thrombolytic Therapy of Patients with Acute Cerebral Infarction

目的探讨急诊诊治流程在急性脑梗死患者超早期溶栓护理中的应用效果。方法我院于2012年1月开始优化并实施急诊诊治流程,包括成立急诊小组、病情评估及分诊、各人员或操作时间优化及脑梗死救治单元,比较急诊诊治流程实施前后溶栓病例数、急诊各环节时间、溶栓后不同时间点NHISS评分及Barthel指数。结果观察组溶栓率、2 h内溶栓率分别为52.0%(26/50)、76.9%(20/26),显著高于对照组的32.0%、37.5%(P<0.05)。观察组溶栓前等待时间(80.5±8.4)min显著短于对照组的(125.5±5.5)min(P<0.01)。观察组溶栓后2 h、7 d、14 d NIHSS评分明显低于对照组,溶栓后7 d、14 d、21 d Barthel指数明显高于对照组,差异均有统计学意义(P<0.05)。结论急诊诊治流程能明显提高急性脑梗死患者超早期溶栓率,显著缩短溶栓前等待时间,有利于患者神经功能缺损恢复及日常生活活动能力提高。

Objective To explore the application effect of emergency diagnosis and treatment in ultra-early nursing of thrombolytic therapy of patients with acute cerebral infarction. Methods proce- Thee- mergency diagnosis and treatment procedure was optimized and implemented in our hospital from January 2012, including the establishment of emergency group, the evaluation and triage of the pathogenetic conditions, the optimization of personnel and the operation time and the units of treating cerebral infarction. The number of patients undergoing thrombolytic therapy, time of the segments of emergency, NHISS scores and Barthel inde- xes at different time points after thrombolytic therapy were compared before and after the implementation of e- mergency diagnosis and treatment procedure. Results The thrombolysis rate and the thrombolysis rate in 2 h of the observation group were 52. 0% （ 26/50 ） and 76. 9% （ 20/26 ）, respectively which were significantly higher than those in the control group（32.0% ,37.5% ） （P 〈 0. 05 ）. The waiting time before thrombolysis of the observation group （80. 5± 8.4）min was significantly shorter than that of the control group （125.5 ± 5.5 ） rain（ P 〈0. 01 ）. 2 h ,7 d and 14 d after thrombolysis,NIHSS scores of the observation group were significantly lower than those of the control group. 7 d, 14 d and 21 d after thrombolysis, Barthel indexes were significantly higher than those of the control group （P 〈 0. 05 ）. Conclusion The emergency diagnosis and treatment pro- cedure can significantly improve the ultra-early thrombolysis rate in patients with acute cerebral infarction, sig- nificantly shorten the waiting time before thrombolysis and is conducive to the recovery of neurological impair- ment and the improvement of daily living activities.