关键节点控制救护模式在急性心肌梗死患者救治中的应用

Application of Critical Control Point rescue mode in the treatment of patients with acute myocardial infarction

目的探究关键节点控制救护模式在急性心肌梗死患者救治中的应用效果。方法2020年10月成立关键节点控制救护模式管理团队,采用便利抽样法,选取2020年10月-2021年10月本院急诊医学科收治的122例急性心肌梗死患者为对照组,应用医疗失效模式与效应分析法分析救护流程关键失效环节,构建关键节点控制救护模式并于2021年11月应用于临床。通过独立样本t检验,比较采用关键节点控制救护模式前后,急性心肌梗死患者急诊治疗情况、心功能恢复情况,记录患者术后30 d内的病死率和住院期间的并发症发生情况。结果应用关键节点管控救护模式后,患者首次医疗接触-球囊扩张时间由(81.9±6.54)min降低到(56.2±4.23)min、首次医疗接触至确诊急性心肌梗死时间由(47.3±5.68)min降低到(30.69±5.21)min,门诊-首次球囊扩张时间由(49.79±13.84)min降低到(28.63±15.71)min,心肌损伤标志物结果时间由(28.38±3.79)min降低到(19.26±2.17)min,心电图报告时间由(5.82±2.01)min降低到(5.14±1.89)min,住院时间由(7.25±2.18)min降低到(6.14±1.27)min,差异比较有统计学意义(P<0.05)。患者抢救后的左心室射血分数较前提高,左心室舒张末期内径和肌钙蛋白水平较前降低,差异有统计学意义(P<0.05)。且低血压、恶性心律失常发生率均较前降低,差异有统计学意义(P<0.05)。结论关键节点控制护理模式可缩短AMI患者的救治时间和住院时间,改善患者心功能,降低住院期间并发症发生风险。

Objective To explore the application effect of key node advanced nursing mode in the treatment of patients with acute myocardial infarction.Methods In October 2020,the hospital established a Critical Control Point rescue mode management team.122 patients with acute myocardial infarction admitted to emergency department of the hospital were enrolled as the objects between October 2020 and October 2021.The healthcare failure mode and effect analysis model was applied to analyze the shortcomings of emergency process,so as to construct critical control point rescue mode in the treatment of patients with acute myocardial infarction and apply it to the clinic in November 2021.After clinical application,emergency nursing and cardiac function recovery were compared between the two groups.The mortality rate within 30 d after surgery and occurrence of complications during hospitalization were recorded.Results The first medical contact to balloon time dropped from(81.9±6.54)min to(56.2±4.23)min.The time from first medical contact to diagnosis of acute myocardial infarction dropped from(47.3±5.68)min to(30.69±5.21)min,the door-balloon dilation time dropped from(49.79±13.84)min to(28.63±15.71)min,producing results time of myocardial injury markers dropped from(28.38±3.79)min to(19.26±2.17)min,reporting time of electrocardiogram dropped from(5.82±2.01)min to(5.14±1.89)min,and hospitalization time dropped from(7.25±2.18)min to(6.14±1.27)min,and the differences were statistically significant(P<0.05).After treatment,left ventricular ejection fraction in observation group was higher than that in control group,left ventricular end-diastolic diameter and cardiac troponin were lower than those in control group(P<0.05).The incidence of hypotension and malignant arrhythmia in observation group was lower than that in control group(P<0.05).Conclusions The critical control point rescue mode can shorten treatment time and hospitalization time in acute myocardial infarction patients,improve cardiac function,and reduce the risk of complications during hospitalization.