摘要
目的通过对急性缺血性脑卒中患者脑血管再通流程进行优化,缩短脑卒中患者院内治疗延误时间。方法成立多学科小组,构建急性缺血性脑卒中患者脑血管再通流程,应用医疗失效模式与效应分析法(healthcare failure mode and effect,HFMEA)对流程步骤进行失效分析,制订并实施管理方案。结果实施流程优化方案后,患者入院至溶栓用药时间(door to needle time,DNT)从88(42,140)min缩短至45(37,59)min(P<0.001);DNT≤60 min的患者比例从20.0%上升至87.7%(P<0.001);入院至动脉血管再通的时间从207(169,227)min缩短至165(155,185)min(P<0.05);脑血管再通率从7.81%提高到13.64%(P<0.05),实施前后患者症状性脑出血发生率及病死率的比较,差异无统计学意义(P>0.05)。结论应用HFMEA优化急性缺血性脑卒中患者脑血管再通流程,可有效地减少院内治疗延误时间。
Objective To optimize the cerebral ischemia-reperfusion process for acute ischemic stroke patients,so as to reduce the time of in-hospital delays. Methods A multi-disciplinary management team was established to de- sign the flowchart of the cerebral ischemia-reperfusion process for acute ischemic stroke patients. By applying Healthcare Failure Mode and Effect（HFMEA） management mode,intervention was conducted and its effect was an- alyzed. Results After implementation of the HFMEA intervention,the door to needle time（DNT）was reduced from 88（42,140） minutes to 45（37,59） minutes（P〈0.001）;the ratio of patients with the DNT〈60 minutes increased from 20% to 87.7%（P〈0.001）;the door to cerebral ischemia-reperfusion time was shortened from 207（169,227） minutes to 165（155,185） minutes（P〈0.05）. There was no significant difference in the incidence and mortality of symptomatic cerebral hemorrhage between before and after intervention （P〉0.05）. Conclusion Utilization of HFMEA to optimize the emergency cerebral ischemia-reperfusion process can effectively reduce the in-hospital delays of acute ischemic stroke patients.
出处
《中华护理杂志》
CSCD
北大核心
2017年第4期449-453,共5页
Chinese Journal of Nursing
基金
上海市卫生和计划生育委员会科研课题面上项目(201540320)
