文章摘要

FOCUS-PDCA模式在急性脑卒中急救流程改造中对患者凝血功能的影响

作者: 1孟玉芝, 1王娟, 1周俊山, 1刘才东, 1王振洁
1 南京医科大学附属南京医院(南京市第一医院)急诊科,南京 210006
通讯: 王娟 Email: wangjuan23ww@163.com
DOI: 10.3978/j.issn.2095-6959.2022.09.010

摘要

目的:探讨FOCUS-PDCA(find-organize-clarity-understand-select-plan-do-check-act)模式在急性脑卒中急救流程改造中对患者凝血功能的影响,分析临床效果。方法:将2020年1月至2022年1月南京市第一医院收治的205例急性缺血性脑卒中(acute ischemic stroke,AIS)溶栓患者纳入研究中,其中2020年1月至2020年12月的105例患者作为对照组,2021年1月至2022年1月收治的110例患者作为研究组。对照组采取常规急救流程,研究组实施基于FOCUS-PDCA模式改造的急救流程,收集两组院内急救流程执行时间,应用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分测定溶栓前、溶栓后24 h及出院时的神经功能恢复情况,并测定溶栓前、溶栓后24 h的血小板(platelet,PLT)计数、活化部分凝血酶时间(activated partial thrombin time,aPTT)变化;计算急救溶栓有效率,并测定两组治疗前、后血清成纤维细胞生长因子4(fibroblast growth factor 4,FGF4)、D-二聚体(D-dimer,D-D)水平。结果:研究组从入院到CT时间、入院到CT报告时间及溶栓时间(door-to-needle time,DNT)均显著短于对照组(均P<0.05)。两组患者溶栓前NIHSS评分差异无统计学意义(P>0.05),溶栓后24 h、出院时的NIHSS评分均比溶栓前显著降低(均P<0.05),且研究组低于对照组(均P<0.05)。研究组溶栓后24 h PLT计数降低,aPTT缩短,且低于或短于对照组(均P<0.05)。研究组急救溶栓有效率为91.82%,对照组为80.95%,两组比较差异有统计学意义(P<0.05)。通过测定,研究组治疗后血清FGF4、D-D水平均低于对照组(均P<0.05)。结论:在急性脑卒中急救中采取基于FOCUS-PDCA模式改造的急救流程有助于缩短急救时间,提升急救溶栓有效率,并可促进神经功能恢复,改善预后,有着重要临床意义。
关键词: FOCUS-PDCA模式;急性脑卒中;急救流程改造;血小板;活化部分凝血酶时间

Effect of FOCUS-PDCA mode on platelet and activated partial thrombin time of patients in the reconstruction of emergency treatment process of acute stroke

Authors: 1MENG Yunzhi, 1WANG Juan, 1ZHOU Junshan, 1LIU Caidong, 1WANG Zhenjie
1 Emergency Department, Nanjing Hospital (Nanjing First Hospital), Nanjing Medical University, Nanjing 210006, China

CorrespondingAuthor: WANG Juan Email: wangjuan23ww@163.com

DOI: 10.3978/j.issn.2095-6959.2022.09.010

Abstract

Objective: To explore the effect of find-organize-clarity-understand-select-plan-do-check-act (FOCUS-PDCA) mode on the coagulation function of patients in the reconstruction of emergency treatment process of acute stroke, and to analyze the clinical effect. Methods: Two hundred and five patients with acute ischemic stroke (AIS) who were admitted to Nanjing First Hospital from January 2020 to January 2022 were enrolled in this study, including 105 patients from January 2020 to December 2020 as the control group, and 110 patients from January 2021 to January 2022 as the study group. The control group adopted conventional emergency treatment procedures, and the research group implemented the first-aid procedure based on the FOCUS-PDCA mode transformation. The execution time of the first-aid procedures in the hospital of the 2 groups was mastered, and the neurological function recovery before and 24 h after thrombolytic treatment and at discharge was measured by National Institute of Health Stroke Scale (NIHSS) score. Platelet (PLT) count and activated partial thrombin time (aPTT) were measured before and 24 h after thrombolytic therapy to master the effective rate of emergency thrombolytic therapy, serum fibroblast growth factor 4 (FGF4) and D-dimer (D-D) levels were determined before and after treatment. Results: The hospitalization to CT time, hospitalization to CT report time, and door-to-needle time (DNT) in the study group were significantly shorter than those in the control group (all P<0.05). There was no significant difference in NIHSS score between the 2 groups before thrombolytic therapy (P>0.05), but the NIHSS score at 24 h after thrombolytic therapy and at discharge was significantly lower than that before thrombolytic therapy (both P<0.05), and the NIHSS score in study group was lower than that in control group (both P<0.05). Twenty-four hours after thrombolytic therapy, PLT count and aPTT in the study group were lower than those in the control group (both P<0.05). The total effective rate of emergency thrombolytic therapy was 91.82% in the study group and 80.95% in the control group, the difference was statistically significant (P<0.05). After treatment, serum FGF4 and D-D levels in the study group were lower than those in the control group, the differences were statistically significant (both P<0.05). Conclusion: In acute stroke emergency treatment, the first aid process based on the FOCUS-PDCA mode is helpful to shorten the first aid time, improve the efficiency of first aid thrombolytic therapy, promote the recovery of neurological function and improve the prognosis, which has important clinical significance.

Keywords: FOCUS-PDCA mode; acute stroke; first aid process transformation; platelets; activate partial thrombin time

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