CAJ | 학술논문

目的：探讨时间目标管理对缩短患者到院至溶栓时间( DNT)的作用。方法对2014年8—10月期间院前接收42例疑似急性缺血性脑卒中( AIS)患者从院前开始到急诊科溶栓期间实行时间目标管理,其他120接收的24例患者从进入急诊科开始,对管理后各阶段目标时间内项目完成合格率及DNT时间与管理前进行比较。结果对照组院前接收发病3 h内的AIS疑似病例42例,按要求完成项目31例,合格率为73.8%；干预组接收38例,按要求完成项目35例,合格率为92.1%,差异有统计学意义(χ2=4.625,P <0.05)。干预组院前急诊科内、CT 检查、溶栓准备合格率分别为100%(38/38)、94.7%(18/19)、94.7%(18/19),均高于对照组的61.9%(26/42)、55.6%(10/18)、58.8%(10/17),差异均有统计学意义(χ2值分别为18.095,5.727,4.779；P<0.05)。对照组溶栓17例,DNT为(68.65±23.75)min,干预组溶栓19例,DNT为(38.37±6.16)min,两组比较差异有统计学意义(Z=5.106,P<0.01)。干预组溶栓患者中我院院前接收的与其他120接收的DNT比较：19例患者中,我院院前接收15例,DNT为(35.50±2.98) min,其他120接收4例,DNT为(46.40±5.68) min,差异有统计学意义(Z=-4.092,P<0.05)。结论合理利用院前时间,将AIS患者溶栓干预流程前移,规范流程,对各环节进行时间目标管理,及时发现超时原因并加以改进,责任到人,可有效地缩短DNT时间,使患者获益。
목적：탐토시간목표관리대축단환자도원지용전시간( DNT)적작용。방법대2014년8—10월기간원전접수42례의사급성결혈성뇌졸중( AIS)환자종원전개시도급진과용전기간실행시간목표관리,기타120접수적24례환자종진입급진과개시,대관리후각계단목표시간내항목완성합격솔급DNT시간여관리전진행비교。결과대조조원전접수발병3 h내적AIS의사병례42례,안요구완성항목31례,합격솔위73.8%；간예조접수38례,안요구완성항목35례,합격솔위92.1%,차이유통계학의의(χ2=4.625,P <0.05)。간예조원전급진과내、CT 검사、용전준비합격솔분별위100%(38/38)、94.7%(18/19)、94.7%(18/19),균고우대조조적61.9%(26/42)、55.6%(10/18)、58.8%(10/17),차이균유통계학의의(χ2치분별위18.095,5.727,4.779；P<0.05)。대조조용전17례,DNT위(68.65±23.75)min,간예조용전19례,DNT위(38.37±6.16)min,량조비교차이유통계학의의(Z=5.106,P<0.01)。간예조용전환자중아원원전접수적여기타120접수적DNT비교：19례환자중,아원원전접수15례,DNT위(35.50±2.98) min,기타120접수4례,DNT위(46.40±5.68) min,차이유통계학의의(Z=-4.092,P<0.05)。결론합리이용원전시간,장AIS환자용전간예류정전이,규범류정,대각배절진행시간목표관리,급시발현초시원인병가이개진,책임도인,가유효지축단DNT시간,사환자획익。
Objective To explore targeted time management to shorten the time from arriving hospital to thrombolysis ( DNT ) . Methods A total of 42 suspected acute ischemic stroke ( AIS ) patients were underwent the targeted time management from pre-hospital until emergency thrombolysis while other 24 cases from 120 to hospital started from the time arriving Emergency Department. The complete rate of targeted time management and DNT compared with before management. Results In the control group, the hospital received 42 pre-hospital patients suspected with AIS in 3 hrs, and completed all targets 31 cases with pass rate of 73. 8%; the experimental group acquired 38 cases and achieved targets 35 cases with pass rate of 92. 1% (χ2 =4. 625,P<0. 05). In the experimental group, the pass rate of pre-hospital Emergency Department, CT detection, thrombolysis preparation were 100% (38/38), 94. 7% (18/19), 94. 7%(18/19) higher than 61. 9% (26/42), 55. 6% (10/18), 58. 8% (10/17) (χ2 =18. 095,5. 727,4. 779;P <0. 05). A total of 17 cases underwent thrombolysis with DNT of ( 68. 65 ± 23. 75 ) min while 19 cases in the experimental group with DNT of (35.50±2.98)min(Z=5.106,P<0.01),and4casescomingfrom120withDNTof(46.40±5.68) min (Z= -4. 092,P <0. 05). Conclusions To utilize pre-hospital time reasonable, we make the thrombolysis process early, regulate the process, manage each segment time targeted, find out and improve the reasons for overdue segment, make clear individual responsibility, which can shorten the DNT and be benefit patients.