心脏大血管外科检验危急值的临床处理分析

Analysis on the management of laboratory critical values in the Department of Cardiovascular Surgery

目的分析总结心脏大血管外科检验危急值的历史数据,为持续改进危急值的处理流程,提高护士的临床护理水平提供依据。方法对2013年4月—2014年4月入住心脏大血管外科的236例患者发生的危急值项目进行回顾性分析。收集整理患者的一般资料,包括危急值类型、数值、分布情况、临床处理时间,以及与危急值相关的并发症。结果纳入患者185例,其中报告危急值208例次,包括血钾99例次(47.60%),血糖13例次(6.25%),血钠11例次(5.29%),肌钙蛋白13例次(6.25%),其他72例次(34.62%);与心脏大血管外科密切相关的危急值有136例次,其中临床处理时间≤15 min 60例次,经再次采集标本复查后确定为假危急值16例次,根据患者病情无需处理11例次(均为肌钙蛋白)。185例患者发生与危急值相关的并发症共27例次,其中与血钾异常相关的心律失常23例次,与血钠异常相关的肌力异常2例次,低血糖反应2例;在对患者危急值进行处理后,相关并发症均消失且未再次出现。结论医护人员应重视危急值,提高对危急值的处理能力,同时应建立完善的临床危急值管理制度及记录处理流程。对于心脏大血管外科护理人员而言,应掌握血钾、血糖、血钠及肌钙蛋白等与专科密切相关的危急值临床知识,以保证能及时有效地实施危急值应对措施,更加准确地处理危急值,实现医疗护理质量的持续改进和提高。

Objective To review and analyze the statistics of laboratory critical values in the Department of Cardiovascular Surgery in order to improve the procedures of dealing with these values and provide references for the enhancement of the nursing level. Methods We retrospectively analyzed laboratory critical values of 236 inpatients in the Department of Cardiovascular Surgery from April 2013 to April 2014. General data of the patients including the type of critical values, the critical value, distribution, clinical processing time and complications related to the critical values.Results A total of 208 laboratory critical values of 185 inpatients were analyzed including abnormal blood potassium was involved in 99（47.60%）; abnormal blood glucose was involved in 13（6.25%）; abnormal blood sodium was involved in11（5.29%）; abnormal blood troponin was involved in 13（6.25%）; and 72 cases had other kinds of critical values（34.62%）.A total of 136 critical values were closely related to the Department of Cardiovascular Surgery. Among them, 60 cases had a processing time of 15 minutes or shorter. After re-examination, 16 were confirmed to be fake critical values; and 11 critical values did not need to be treated according to the condition of the patients. There were altogether 27 cases of complications related to critical values, including 23 cases of arrhythmia related to abnormal blood potassium, 2 cases of abnormal muscle strength caused by abnormal blood sodium, and 2 cases of hypoglycemia. After the critical values were handled, related complications disappeared without any recurrence. Conclusions Perfect regulatory regime and process of recording and handling laboratory critical values are important for nurses in our department to carry out more accurate measures in treating these critical values including abnormal blood potassium, blood glucose, blood sodium, and blood troponin, etc.In order to continuously improve medical and nursing quality, nurses should pay more attention to the identification and treatment of laboratory critical values.