血管外科病变检验中危急值的临床应对与处理分析

Clinical response and treatment of critical value in lesion examination of vascular surgery

目的 通过分析和总结血管外科既往性检验危急值的治疗数据,为不断改进血管外科危急值处理方法程序及其相关治疗、提高医护人员的救治能力提供依据.方法 回顾性分析2020年5月至2021年5月四川大学华西医院收治的852例患者所发生的风险和血液检查中的危急值项目情况,并按照ICD-10的诊断标准纳入535例患者,主要排除了静脉曲张患者.分析患者的基本信息及危急阈值的分布情况.结果 将与危急值相关的并发症研究结果纳入535例患者中,其中危急值报告患者共206例,其中与血管外科疾病密切相关的危急值报告患者188例.与血管外科疾病密切相关的危急值中,血钾异常101例,血钠异常8例,血糖异常12例,肌钙蛋白水平升高37例,活化部分凝血活酶时间(APTT)异常30例.在全部危急值中,临床处理时间≤15 min的患者占比最高;经再次收集标本并进行复查后认定真实危急值患者11例.535例患者中,发生与危急值有关并发症的患者28例,其中,严重不良反应相关心律失常患者22例,相关肌力异常患者3例,低血糖患者3例.经治疗后,并发症均已完全消失且未再出现.结论 各级医院血管外科的临床医护人员不仅应该高度重视危急点数值的及时甄别,提高及时应变和应急处理控制能力,还应研究建立一套较为完善的关于各级血管医学外科专业临床危急点数值的甄别管理体系、规章制度,以及危急值甄别记录和应急处理控制工作具体流程,同时要求充分、准确地掌握患者血钾、血糖、血钠、肌钙蛋白、凝血酶的持续时间等危急值,以及与专业密切相关的基本知识点,以便保证能够及时、有效地采取正确危急值的处理措施,更加科学精细化地进行紧急处理,实现血管外科医护人员服务质量的改进和临床技术的提高.

Objective To provide evidence for continuously improving the critical value processing methods and related treatments of vascular surgery and improving the treatment ability of medical staff by analyzing and summarizing the previous critical value data of vascular surgery. Method The risk and critical value items in blood examination of 852 patients admitted to West China Hospital, Sichuan University from May 2020 to may 2021 were analyzed retrospectively, and 535 patients were included according to the diagnostic criteria of international classification of disease 10(ICD-10), mainly excluding varicose vein patients. The basic information of patients and the distribution of critical threshold were analyzed. Result The study results of complications related to critical value were included in 535patients, of which 206 patients reported critical value. The critical value closely related to vascular surgical diseases was reported in 188 patients. Among the critical values closely related to vascular surgical diseases, there were 101 patients with abnormal blood potassium, 8 patients with abnormal blood sodium, 12 patients with abnormal blood glucose and 37 patients with elevated troponin level, 30 patients with abnormal activated partial thromboplastin time(APTT).Among all the critical values, the patients with clinical treatment time ≤15 min accounted for the highest proportion;11 patients with true critical value were identified after recollection and reexamination. Among the 535 patients, 28 patients had complications related to critical value, including 22 patients with arrhythmia related to serious adverse reactions, 3patients with related muscle strength abnormalities and 3 patients with hypoglycemia. After treatment, the complications had completely disappeared and did not recur. Conclusion The clinical medical staff of vascular surgery in hospitals at all levels should not only emphasize the timely identification of critical point values, improve the ability of timely response and emergency treatment of critical values, but also establish a relatively complete set of clinical critical value screening and management system, rules, critical value screening records and specific process for emergency treatment for vascular surgery professionals. It is also required to fully and accurately know the patient’s blood potassium, sugar,sodium, troponin, thrombin time and the basic knowledge points closely related to the profession, so as to ensure timely,effective and correct critical value treatment, and more scientific emergency treatment to realize improvement and enhancement of service quality and clinical technical performance.