精益组织化管理Solitaire AB支架取栓术治疗急性大动脉闭塞性脑梗死的研究
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摘要
目的探讨医院内精益组织化管理后Solitaire AB支架介入取栓治疗急性大动脉闭塞性脑梗死的应用疗效。方法本项目主要针对大动脉闭塞性急性脑梗死(LAO)患者,2015年8月到2017年2月共31例,在发病时间窗内,通过院内精益组织化管理,使用蓝牙手环实时监控,不断的优化绿色通道流程,逐步控制DNT及介入血管再通时间;成熟的应用Solitaire AB支架取栓技术。通过比较控制DNT时间,患者入院及术前术后NIHSS评分,术后mRS评分进行统计学分析。结果本组31例患者中前循环24例,其中大脑中动脉闭塞16例,颈内动脉闭塞7例,大脑前动脉闭塞1例,后循环7例,其中基底动脉闭塞6例,椎动脉闭塞1例,平均DNT时间为56.4min,1例开通后闭塞,1例开通后术中出血予球囊再次闭塞,其余全部患者血管开通TICI评分≥2b,植入9枚支架,术后颅内出血3例,术后NIHSS评分明显下降,术前术后对比P<0.05,具有统计学意义,3月及6月随访结果良好,mRS评分≤2分19例(61.3%),3分8例,4-5分2例,死亡2例。结论通过医院精益组织化管理降低入院后DNT时间,对于Solitaire AB支架介入取栓治疗急性大动脉闭塞性脑梗死具有重要意义,可以减少该类疾病带来的高致死致残率。
Objective To investigate the effect of lean organizational management in the hospital after Solitaire AB stent intervention in treating acute cerebral infarction with large cerebral artery occlusion. Methods the project is mainly aimed at artery occlusion in patients with acute cerebral infarction(LAO),During the period from Aug 2015 to Feb 2017,a total of 31 cases,in the time window,through in the lean organization management,such as using the bluetooth bracelet real-time monitoring,constantly optimize the green channel process,step by step control DNT and interventional recanalization time;The application of mature apple strudel AB stents should technology. By comparing the control DNT time,patients admitted to hospital and preoperative postoperative NIHSS score,m RS score after statistical analysis. Results 31 patients first 24 cases,including 16 cases of middle cerebral artery occlusion,internal carotid artery occlusion 7 cases,1 case before the cerebral artery occlusion,posterior circulation in7 cases,including 6 cases of basal artery occlusion,vertebral artery occlusion in 1 case,the average DNT time was 56.4 min,1 case was opened after occlusion patency,Intraoperative hemorrhage in 1 case after opening to the balloon occlusion again,all patients TICI score 2 b,or nine stents,NIHSS score significantly decreased postoperatively,preoperative postoperative contrast(P<0.05),statistically significant,3 month and 6 month follow-up results were good,m RS score 2 points or less 19 cases(61.3%),3 points in 8,4 to 5 points in 2 patients,2 cases died. Conclusion Through the hospital lean organizational management to reduce the DNT time after admission,for Solitaire AB stent intervention in treating acute artery occlusive cerebral infarction is of great significance,can reduce the high death from the disease morbidity.
Objective To investigate the effect of lean organizational management in the hospital after Solitaire AB stent intervention in treating acute cerebral infarction with large cerebral artery occlusion. Methods the project is mainly aimed at artery occlusion in patients with acute cerebral infarction(LAO),During the period from Aug 2015 to Feb 2017,a total of 31 cases,in the time window,through in the lean organization management,such as using the bluetooth bracelet real-time monitoring,constantly optimize the green channel process,step by step control DNT and interventional recanalization time;The application of mature apple strudel AB stents should technology. By comparing the control DNT time,patients admitted to hospital and preoperative postoperative NIHSS score,m RS score after statistical analysis. Results 31 patients first 24 cases,including 16 cases of middle cerebral artery occlusion,internal carotid artery occlusion 7 cases,1 case before the cerebral artery occlusion,posterior circulation in7 cases,including 6 cases of basal artery occlusion,vertebral artery occlusion in 1 case,the average DNT time was 56.4 min,1 case was opened after occlusion patency,Intraoperative hemorrhage in 1 case after opening to the balloon occlusion again,all patients TICI score 2 b,or nine stents,NIHSS score significantly decreased postoperatively,preoperative postoperative contrast(P<0.05),statistically significant,3 month and 6 month follow-up results were good,m RS score 2 points or less 19 cases(61.3%),3 points in 8,4 to 5 points in 2 patients,2 cases died. Conclusion Through the hospital lean organizational management to reduce the DNT time after admission,for Solitaire AB stent intervention in treating acute artery occlusive cerebral infarction is of great significance,can reduce the high death from the disease morbidity.
引文
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[5]王爱华,李丰章,邹南安,等.3D-ASL联合SWI、DWI多模态检查技术在急性脑梗死溶栓治疗中评估价值的研究[J].江西医药,2016,51(12):1454-1456.
[6]赖贤良,毛国华,朱建明,等.颅内动脉溶栓联合支架取栓治疗急性脑梗死2例报道[J].江西医药,2015,50(1):25-27.
[7]缪中荣.急性期缺血性卒中血管内治疗:春天真的来了吗?[J].中国卒中杂志,2017,12(7):575-578.
[8]王云玲,毛玲群,程玲丹.精益管理可控制急性缺血性脑卒中静脉溶栓门-针时间[J].中华危重症急救医学,2016,28(9):853-856.
[9]Jaban R.Solitaire flow-estoration device for treatment of acute ischemic stroke:safty and recanalization efficacy study in a swine vesselocclusion model[J].AJNR,2010,31:1938.
[2]Novakovic RL,Toth G,Narayanan S,et al.Retrievable stents,“stentrievers”for endovaseular acute ischemic stroke therapy[J].Neuralogy,2012,79:148.
[3]中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志,2015,10(7):590-606.
[4]朱海燕,韩国鑫,宋扬,等.远程系统运用在急诊教学中的探索与实践[J].中国急救复苏与灾害医学杂志,2016,(11).
[5]王爱华,李丰章,邹南安,等.3D-ASL联合SWI、DWI多模态检查技术在急性脑梗死溶栓治疗中评估价值的研究[J].江西医药,2016,51(12):1454-1456.
[6]赖贤良,毛国华,朱建明,等.颅内动脉溶栓联合支架取栓治疗急性脑梗死2例报道[J].江西医药,2015,50(1):25-27.
[7]缪中荣.急性期缺血性卒中血管内治疗:春天真的来了吗?[J].中国卒中杂志,2017,12(7):575-578.
[8]王云玲,毛玲群,程玲丹.精益管理可控制急性缺血性脑卒中静脉溶栓门-针时间[J].中华危重症急救医学,2016,28(9):853-856.
[9]Jaban R.Solitaire flow-estoration device for treatment of acute ischemic stroke:safty and recanalization efficacy study in a swine vesselocclusion model[J].AJNR,2010,31:1938.