基于医疗失效模式与效应分析模式对急性缺血性脑卒中急救效果的影响

The impact of medical failure mode and effect analysis mode on the emergency response effect of acute ischemic stroke

目的:探讨基于医疗失效模式与效应分析(HFMEA)模式的优化护理方案在急性缺血性脑卒中(AIS)静脉溶栓中的应用效果,并分析对神经功能的影响。方法:选择2021年6月-2022年6月接受治疗的AIS静脉溶栓患者120例,根据随机投币法分为接受常规急救流程干预的对照组(n=60)和接受基于医疗失效模式与HFMEA模式的优化护理干预的观察组(n=60),比较两组患者入院至完成各环节用时、神经功能以及溶栓效率,随访1年后,统计预后情况。结果:观察组患者入院至分诊完成时间、分诊完成至CT检查时间、CT检查结束至药物首推时间、入院至开始静脉溶栓时间均低于对照组,差异有统计学意义(P<0.05)。治疗7 d后,两组患者的美国国立卫生研究院卒中量表评分、神经元特异性烯醇化酶、中枢神经特异蛋白β水平均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组患者的入院至静脉溶栓开始时间≤60 min的达标率、血管再通率、溶栓有效率均高于对照组,差异有统计学意义(P<0.05)。随访1年,观察组无明显功能障碍、轻度残疾率均高于对照组(P<0.05),明显残疾率低于对照组,差异有统计学意义(P<0.05)。两组患者死亡率比较,差异无统计学意义(P>0.05)。结论:基于医疗失效模式与HFMEA模式的优化护理方案可显著缩短AIS患者静脉溶栓的各环节用时,提高溶栓效率,有利于神经功能的恢复和预后情况的改善。

Objective:To explore the application effect of optimized nursing scheme based on healthcare failure mode and effect analysis(HFMEA)mode in intravenous thrombolysis of acute ischemic stroke(AIS),and to analyze the effect on neurological function.Methods:According to the random coin method,120 patients with AIS intravenous thrombolysis who were treated in hospital from June 2021 to June 2022 were divided into control group(n=60)who received AIS emergency routine first aid process and observation group(n=60)who received optimized nursing based on HFMEA model.The time of admission to completion of each link,neurological function and thrombolysis efficiency were compared between the two groups.After 1 year of follow-up,the prognosis was counted.Results:The time from admission to the completion of the triage,the time from the completion of the triage to the CT examination,the time from the end of the CT examination to the first push of the drug,and the time from admission to the beginning of intravenous thrombolysis in the observation group were lower than those in the control group(P<0.05).After 7 days of treatment,the scores of national institutes of health stroke scale,neuron-specific enolase and central nervous system specific proteinβin the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(P<0.05).The compliance rate,vascular recanalization rate and thrombolytic effective rate of patients in the observation group were higher than those in the control group(P<0.05).After 1 year of follow-up,the number of cases with no obvious dysfunction and mild disability in the observation group was higher than that in the control group(P<0.05),and the number of cases with obvious disability was lower than that in the control group(P<0.05).There was no significant difference in the number of deaths between the two groups(P>0.05).Conclusion:The optimized nursing program based on HFMEA model can significantly shorten the time of intravenous thrombolysis in AIS patients,promote the improvement of thrombolysis efficiency,and is conducive to the recovery of neurological function and the improvement of prognosis.