移动卒中单元救治流程的优化及应用效果

doi:10.3761/j.issn.0254-1769.2021.08.004

摘要/Abstract

摘要：

目的探讨优化移动卒中单元（mobile utroke unit,MSU）救治流程对急性缺血性脑卒中患者的效果。方法回顾性分析该院2020年1月—6月MSU出车接诊的30例急性缺血性脑卒中静脉溶栓患者,其中MSU救治流程优化后静脉溶栓的18例患者为试验组,MSU运行初期、流程优化前实施静脉溶栓的12例患者为对照组。收集两组的临床资料,比较两组的护理效率及临床结局。结果试验组的卒中专科护士首次静脉穿刺成功例数、发病至静脉溶栓时间、呼叫120至静脉溶栓时间、MSU到达现场至静脉溶栓时间均优于对照组,差异具有统计学意义（P<0.05）。两组发病至呼叫120时间、呼叫120至MSU到达现场时间、静脉溶栓24 h内症状性颅内出血例数、静脉溶栓后90 d改良Rankin量表评分≤2分的例数比较,差异无统计学意义（P>0.05）。结论通过优化救治流程可有效缩短患者发病至静脉溶栓时间、呼叫120至静脉溶栓时间及MSU到达现场至静脉溶栓时间,提高护士工作效率,提升患者救治质量。

关键词: 流程优化, 移动卒中单元, 急性缺血性卒中, 卒中专科护士, 静脉溶栓, 急救医疗服务

Abstract:

Objective To explore the effect of optimizing the treatment process of Mobile Stroke Unit（MSU） on patients with acute ischemic stroke（AIS）. Methods A retrospective analysis was performed on 30 patients with AIS intravenous thrombolysis treated by MSU in our hospital from January to June 2020. Among them,18 patients who received intravenous thrombolysis after MSU process optimization were included in the experimental group,and 12 patients who received intravenous thrombolysis before MSU process optimization in the early operation were included in the control group.The clinical data of the 2 groups was collected,and the nursing efficiency and clinical outcome of the 2 groups were compared. Results In the experimental group,the success rate of the first venous puncture,the time from calling 120 to intravenous thrombolysis,the time from MSU arriving at the scene to intravenous thrombolysis,and the time from onset to intravenous thrombolysis were better than those in the control group,with statistical significance（P<0.05）. There was no significant difference between the time from onset to call 120,the time from call 120 to MSU arrival,the proportion of symptomatic intracranial hemorrhage within 24 h after intravenous thrombolysis,and the ratio of Modified RankinScale（MRS）≤2 at 90 d after thrombolysis（P>0.05）.Conclusion The optimization of the treatment process can effectively shorten the time from onset to intravenous thrombolysis,call 120 to intravenous thrombolysis and the time from MSU to intravenous thrombolysis,and it can also significantly improve the work efficiency of nurses and the quality of patient treatment.

Key words: Process Optimization, Mobile Stroke Unit, Acute Ischemic Stroke, Stroke Nurse, Intravenous Thrombolysis, Emergency Medical Services

郭修凯,姜秀霞,张瑞敏,刘卫东,王风云,张萌,张利勇,王继跃. 移动卒中单元救治流程的优化及应用效果[J]. 中华护理杂志, 2021, 56(8): 1145-1150.

GUO Xiukai,JIANG Xiuxia,ZHANG Ruimin,LIU Weidong,WANG Fengyun,ZHANG Meng,ZHANG Liyong,WANG Jiyue. Effect of optimization of mobile stroke unit treatment process on patients with acute ischemic stroke[J]. Chinese Journal of Nursing, 2021, 56(8): 1145-1150.

图/表 5

图1 流程优化后MSU救治流程图注：MSU为移动卒中单元;APP为手机应用程序。

Figure 1 MSU first aid procedures after process optimization

图2 流程优化前MSU救治流程图注：MSU为移动卒中单元;APP为手机应用程序。

Figure 2 MSU first aid flow chart before process optimization

表1 两组一般资料比较

Table 1 Comparison of the general information of the two groups of patients

表2 两组救治流程中各时间节点比较（min,$\bar{x}$±s）

Table 2 Comparison of the time nodes in the treatment process between two groups of patients（min,$\bar{x}$±s）

表3 两组患者救治效果比较（例）

Table 3 Comparison of treatment effect between the two groups（case）

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