系统护理干预对提高缺血性脑卒中患者时间窗内就诊率的研究
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摘要
目的探讨系统护理干预措施对提高缺血性脑卒中患者时间窗内就诊率的成效。方法将2015年1-12月,某院神经内科收治的缺血性脑卒中患者设为对照组,回顾性调查其时间窗内就诊率、静脉溶栓率、就诊-应用静脉溶栓药时间(door-to-needle time,DNT)。自2016年1月开始从急诊、病房、出院后三个时间段落实护理干预措施,统计2016年1-12月该院同类患者(观察组)6h内就诊率、溶栓率、DNT≤60min溶栓率等,并与对照组比较。结果对照组6h内就诊率为35.4%,低于观察组的44.8%,差异有统计学意义(P<0.01);对照组DNT≤60 min溶栓率为10.0%,明显低于观察组的43.2%,差异有统计学意义(P<0.01)。观察组中,有36例患者在2小时内溶栓,有68例患者在4.5小时内溶栓,分别占56.3%、38.2%。结论系统护理干预在患者急救流程时间控制方面有着积极作用。
Objective To investigate the effect of systemic intervention in improving hospitalization rate of ischemic stroke patients within time window.Methods Ischemic stroke patients admitted in the hospital in the year of 2015 were set as control group.The hospitalization rate,venous thrombolysis rate and door-toneedle time(DNT)were investigated retrospectively.The control group received nursing interventions for acute ischemic stroke in emergency room,ward and after discharge.Stroke patients admitted in the year of2016 were set as observation group.The treatment rate within 6 h,thrombolysis rate and DNT less than 60 min were collected in the observation group,and were compared with those in the control group.ResultsThe hospitalization rate within 6 hin control group was 35.4%,which was lower than observation group(44.8%),the difference was statistically significant(P< 0.01).Thrombolyses rate of DNT less than 60 min in the control group was 10%,which was significantly lower than the observation group(43.2%),and the difference had statistical significance(P<0.01).In the observation group,36 patients had thrombolysis within 2 hours,68 patients had thrombolysis within 4.5 hours,accounting for 56.3%and 38.2%,respectively.Conclusions Systematic nursing intervention plays a positive role in the time control of treating the ischemic stroke patients.
Objective To investigate the effect of systemic intervention in improving hospitalization rate of ischemic stroke patients within time window.Methods Ischemic stroke patients admitted in the hospital in the year of 2015 were set as control group.The hospitalization rate,venous thrombolysis rate and door-toneedle time(DNT)were investigated retrospectively.The control group received nursing interventions for acute ischemic stroke in emergency room,ward and after discharge.Stroke patients admitted in the year of2016 were set as observation group.The treatment rate within 6 h,thrombolysis rate and DNT less than 60 min were collected in the observation group,and were compared with those in the control group.ResultsThe hospitalization rate within 6 hin control group was 35.4%,which was lower than observation group(44.8%),the difference was statistically significant(P< 0.01).Thrombolyses rate of DNT less than 60 min in the control group was 10%,which was significantly lower than the observation group(43.2%),and the difference had statistical significance(P<0.01).In the observation group,36 patients had thrombolysis within 2 hours,68 patients had thrombolysis within 4.5 hours,accounting for 56.3%and 38.2%,respectively.Conclusions Systematic nursing intervention plays a positive role in the time control of treating the ischemic stroke patients.
引文
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[2]中国心脑血管病网.脑卒中高危人群筛查和干预项目简介[EB/OL].[2013-06-21]http://www.cnstroke.com/NewsInFo/News/NewsDetailWeb?Tid=1224,2013-06-21.
[3]段云霞,陈小玉,张梓倩,等.缺血性脑卒中治疗药物研究进展[J].中央民族大学学报:自然科学版,2012,21(2):65-70.
[4]LEIRA E C,LUDWIG B R,GUROL M E,et al.The types of neurological deficits might not justify withholding treatment in patients with low total National Institutes of Health Stroke Scale scores[J].Stroke,2012,43(3):782-786.
[5]STECKSEEN A,ASPLUND K,APPELROS P,et al.Thrombolytic therape rates and stroke severity:an analysis of date from the Swedish stroke register(riksstroke)2007-2010[J].Stroke,2012,43(2):536-538.
[6]黄小钦,贾建平,刘丽旭,等.早期就诊的急性缺血性脑卒中病人未溶栓原因分析[J].脑与神经疾病杂志,2007,15(5):346-348.
[7]MERETOJA A,KESHTKARAN M,SAVER J L,et al.Stroke thrombolysis:save a minute,save a day[J].Stroke,2014,45(4):1053-1058.
[8]徐敏,王惠琴,杨红燕,等.院内卒中应急流程在急性脑梗死溶栓治疗中的应用[J].中华护理杂志,2012,47(3):204-205.
[9]强彩芹,贾艳霞,王志利,等.绿色通道救治用于急性脑梗死溶栓中的护理[J].当代护士:专科版,2010(11):16-17.
[10]中国卒中学会科学声明专家组.急性缺血性卒中静脉溶栓中国卒中学会科学声明[J].中国卒中杂志,2017,12(3):267-284.
[11]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华医学信息导报,2010,25(14):16-19.
[12]Nor A M,McAllister C,Louw S J,et al.Agreement between ambulance paramedic-and physician-recorded neurological signs with face arm speech test(FAST)in acute stroke patients[J].Stroke,2004,35(6):1355-1359.
[13]江苏省省级机关医院.护理常规[M].上海:科学技术出版社,1999:8.
[14]WANG Y,LIAO X,ZHAO X,et al.Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China:analysis of the results from the Chinese national stroke registry(CNSR)[J].Stroke,2011,42(6):1658-1664.
[15]中国脑卒中医疗治疗评估(QUEST)协作组.中国急性缺血性脑卒中治疗现状[J].中华神经科杂志,2009,42(4):223-227.
[16]HSIEH F I,LIEN L M,CHEN S T,et al.Get with the guidelines-stroke performance indicators:surveillance of stroke care in the Taiwan stroke registry:get with the guidelines-stroke in Taiwan[J].Circulation,2010,122(11):1116-1123.
[17]EISSA A,KRASS I,LEVI C,et al.Understanding the reasons behind the low utilisation of thrombosis in stroke[J].Australas Med J,2013,6(3):152-167.
[18]赵颖,辛秀峰,徐安定,等.关键医疗质量指标监控对提高缺血性脑血管病临床医疗质量的作用[J].暨南大学学报:医学版,2013,34(2):186-190.
[19]FONAROW G C,REEVES M J,SMITH E E,et al.Characteristics,performance measures,and in-hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelinesstroke[J].Circ Cardiovasc Qual Outcomes,2010,3(3):291-302.
[20]WARDLAW J M,MURRAY V,BERGE E,et al.Recombinant tissue plasminogen activator for acute ischaemic stroke:an updated systematic review and meta-analysis[J].Lancet,2012,379(9834):2364-2372.
[21]朱银潮,沈一鸣,丁十戈,等.社区高血压俱乐部“1+1”健康教育模式效果评价[J].中国健康教育,2005,21(3):171-174.
[22]包家明,霍杰.护理健康教育概论[M].北京:中国中医药出版社,2007:212-223.
[23]WONG F K,CHOW S K,CHAN T M.Evaluation of a nurse-led disease management programme for chronic kidney disease:a randomized controlled trial[J].Int J Nurs Stud,2010,47(3):268-278.
[24]王少玲,黄金月,周家仪.建立慢性阻塞性肺疾病延续护理的循证实践[J].中华护理杂志,2009,44(5):431-434.
[25]刘英,韩小云,赵惠平.医护合作临床路径对于癌症病人实施健康教育的效果[J].全科护理,2011,9(10A):2718-2719.
[26]赵卫红.医护合作健康教育模式在医院普外科护理中的应用[J].护理研究:下旬版,2014,28(1):337-338.
[27]王作振,闫宝华,王克莉.同伴教育及其研究状况[J].中国健康教育,2004,20(5):429-430.
[28]黄琦,林泽娜,官玲燕,等.同伴支持在老年2型糖尿病患者健康教育中的实施[J].护理学报,2013,20(7A):70-72.
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