缩短AMI患者FMC-to-B时间的集束化管理模式的构建及应用OA
Construction and application of a cluster management model for shortening FMC-to-B time in patients with acute myocardial infarction
目的 构建缩短急性心肌梗死(AMI)患者首次接触医疗到球囊扩张(FMC-to-B)时间的集束化管理模式,并分析其应用价值.方法 通过查阅相关文献、总结临床工作经验,构建缩短FMC-to-B时间的集束化管理模式.采用前瞻性随机对照研究,选取2020年1月至2023年1月商丘市第一人民医院收治的121例AMI患者作为研究对象,采用随机数字表法+密封信法将患者分为对照组与观察组.研究期间对照组未有脱落,共61例;其中男28例,女33例;年龄42～56(50.30±4.50)岁;Killip心功能分级:Ⅰ级32例、Ⅱ级27例;采用常规护理.观察组因延迟实施经皮冠脉介入术(PCI)脱落1例,共59例;其中男35例,女24例;年龄42～56(50.42±4.56)岁;Killip心功能分级:Ⅰ级37例、Ⅱ级24例;在对照组基础上,采用缩短FMC-to-B时间的集束化管理模式干预,其主要内容有构建医护团队、建立缩短FMC-to-B时间模式等.比较两组患者临床指标、救治情况、并发症、经济指标以及护理满意度.采用独立样本t检验、x2检验和秩和检验.结果 观察组患者确诊AM1时间、FMC-to-B时间及导管室激活时间均短于对照组[(582.61±10.36)s比(602.67±10.07)s、(110.61±9.48)min比(125.77±11.81)min、(19.85±3.94)min 比(28.39±5.82)min],差异均有统计学意义(t=10.758、7.737、9.386,均P＜0.05).观察组梗死血管再通率、存活率均高于对照组[94.92％(56/59)比83.61％(51/61)、93.22％(55/59)比80.33％(49/61)],差异均有统计学意义(x2=3.971、4.314,均P＜0.05).两组患者并发症总发生率比较[13.56％(8/59)比18.03％(11/61)],差异无统计学意义(x2=0.450,P＞0.05).观察组住院时间短于对照组、住院费用低于对照组[(8.95±1.84)d比(10.95±1.51)d、(39 503.25±600.36)元比(43 981.22±586.37)元],差异均有统计学意义(t=6.519、41.335,均P＜0.05).观察组护理满意度高于对照组,差异有统计学意义(Z=2.003,P＜0.05).结论 缩短AMI患者FMC-to-B时间的集束化管理模式的构建及应用可以有效缩短确诊AMI时间、FMC-to-B时间、导管室激活时间及住院时间,提高血管再通率与存活率,减少住院费用,且能提高患者的护理满意度.
Objective To construct a cluster management model that shortens the time from first medical contact to balloon(FMC-to-B)in patients with acute myocardial infarction(AMI),and analyze its application value.Methods By consulting relevant literatures and summarizing clinical work experiences,a cluster management model for shortening FMC-to-B time was constructed.A prospective randomized controlled study was conducted,selecting 121 AMI patients in Shangqiu First People's Hospital from January 2020 to January 2023 as the study subjects.The patients were divided into a control group and an observation group using the random number table method+sealed letter method.During the study period,the control group did not fall off,a total of 61 cases.There were 28 males and 33 females,aged 42-56(50.30±4.50)years,Killip cardiac function classification:32 cases of grade Ⅰ and 27 cases of grade Ⅱ,and routine nursing was used.In the observation group,1 case fell off due to delayed percutaneous coronary intervention(PCI),a total of 59 cases.There were 35 males and 24 females,aged 42-56(50.42±4.56)years,Killip cardiac function classification:37 cases of grade Ⅰ and 24 cases of grade Ⅱ.On the basis of the control group,the cluster management mode of shortening FMC-to-B time was used to intervene,the main contents were to build a medical team and establish a shortening FMC-to-B time model.The clinical indicators,treatment,complications,economic indicators and nursing satisfaction were compared between the two groups.Independent sample t test,x2 test,and rank sum test were used for statistical analysis.Results The AMI diagnosis time,FMC-to-B time,and catheter room activation time in the observation group were shorter than those in the control group[(582.61±10.36)s vs.(602.67±10.07)s,(110.61±9.48)min vs.(125.77±11.81)min,(19.85±3.94)min vs.(28.39±5.82)min],with statistically signiJicant differences(t=10.758,7.737,and 9.386,all P＜0.05).The revascularization rate of infarction and survival rate in the observation group were higher than those in the control group[94.92％(56/59)vs.83.61％(51/61),93.22％(55/59)vs.80.33％(49/61)],with statistically significant differences(x2=3.971 and 4.314,both P＜0.05).There was no statistically significant difference in the total incidence of complications between the two groups[13.56％(8/59)vs.18.03％(11/61)](x2=0.450,P＞0.05).The hospitalization time of the observation group was shorter than that of the control group,and the hospitalization cost was lower than that of the control group[(8.95±1.84)d vs.(10.95±1.51)d,(39 503.25±600.36)yuan vs.(43 981.22± 586.37)yuan],with statistically significant differences(t=6.519 and 41.335,both P＜0.05).The nursing satisfaction of the observation group was higher than that of the control group,with a statistically significant difference(Z=2.003,P＜0.05).Conclusion The construction and application of a cluster management model for shortening the FMC-to-B time of AMI patients can effectively shorten the AMI diagnosis time,FMC-to-B time,catheter room activation time,and hospitalization time,improve the vascular recanalization and survival rates,reduce the hospitalization costs,and improve the patients'nursing satisfaction.
陈贝;金爱莲
商丘市第一人民医院急诊内科,商丘 476000
急性心肌梗死集束化管理首次接触医疗到球囊扩张时间
J Acute myocardial infarctionCluster managementFirst medical contact to balloon time
《国际医药卫生导报》 2024 (008)
1286-1290 / 5
2020年河南省医学科技攻关联合共建项目(LHGJ20200931) 2020 Henan Province Medical Science and Technology Joint Construction Project(LHGJ20200931)
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