中国全科医学2017，Vol.20Issue(24)：2972-2977,6.DOI:10.3969/j.issn.1007-9572.2017.24.007
持续质量改进在缩短行静脉溶栓治疗的急性缺血性脑卒中患者入院至给予静脉溶栓治疗时间中的临床价值
Clinical Value of Continuous Quality Improvement in Shortening the DNT of Acute Ischemic Stroke Patients with Intravenous Thrombolysis
摘要
Abstract
Objective To explore the clinical value of continuous quality improvement(CQI) in shortening the Door-to-needle time(DNT) of acute ischemic stroke(AIS)patients with intravenous thrombolysis(IVT),in order to improve the clinical prognosis of patients with AIS.Methods From January 2010 to June 2016,88 patients with AIS who were treated by IVT,met the inclusion criteria and admitted to the Second Affiliated Hospital(Jiande Branch),School of Medicine,Zhejiang University were enrolled.Nine non-emergency patients were excluded,and 79 patients were included in the study finally.They were grouped according to the implementation of CQI or not.That was,patients before January 2015 were divided into before improvement group(46 cases),patients after April 2015 were divided into the after improvement group(33 cases).From January 2010 to December 2014,the average DNT of AIS patients was 101.2 minutes in our hospital,which was higher than the 60 minutes required by the American Heart Association/American Stroke Association guidelines in 2013.Therefore,from January to April in 2015,the processes of the diagnosis and treatment AIS patients were managed by using CQI concepts and methods,so that the AIS patients eligible for IVT were given IVT within 60 minutes of arriving in the emergency room.The observation time ended 3 months after the patient accepted intravenous thrombolysis.The main evaluation indicators of the two groups were compared,including the door-to-CT scan time,CT scan-to-needle times,DNT,score of the National Institute of Health Stroke Scale(NIHSS)24 hours and 7 days after IVT,the incidence of symptomatic deterioration and symptomatic intracranial hemorrhage(ICH) within 7 days after IVT,the score of Modified Rankin Scale(mRS) 3 months after IVT,the rates of good prognosis and case fatality.Results In order to ensure the comparability of age,the incidence of diabetes and NIHSS between the two groups′ patients,some patients were excluded and 35 cases of the before improvement group and 20 cases of the after improvement group were enrolled finally.The CT scan-to-needle time and DNT of the after improvement group were shorter than those of the before improvement group(P<0.05).There were no statistically significant differences in the door-to-CT scan time,the scores of NIHSS 24 hours and 7 days after IVT,the incidence of symptomatic deterioration and symptomatic ICH within 7 days after IVT,the score of mRS 3 months after IVT,the rates of good prognosis and case fatality between the two groups(P>0.05).Conclusion The clinical value of CQI in shortening DNT of AIS patients with IVT is significant,and it can bring better economic and social benefits.It is worth further promotion in primary hospitals.关键词
脑梗死/血栓溶解疗法/入院至给予静脉溶栓治疗时间/持续质量改进Key words
Infarction/Thrombolytic therapy/Door-to-needle time/Continuous quality improvement分类
医药卫生引用本文复制引用
傅晓,赵西耀,王力,李向新,刘兰芹,吴慧平..持续质量改进在缩短行静脉溶栓治疗的急性缺血性脑卒中患者入院至给予静脉溶栓治疗时间中的临床价值[J].中国全科医学,2017,20(24):2972-2977,6.基金项目
建德市科技发展计划项目(2014M02) （2014M02）
