| 摘要: |
| 目的 评价问题解决型品管圈活动在规范急性缺血性脑卒中（AIS）患者血管内治疗术后抗血小板药物使用中的应用效果。方法 建立品管圈，并将活动主题确定为“缩短AIS患者血管内治疗后抗血小板药物序贯治疗时间”。选择2019年1月至2020年12月（实施品管圈活动前）121例于我中心行机械取栓桥接抗血小板药物序贯治疗的AIS患者，分析影响抗血小板药物序贯治疗时间不达标的主要因素，拟定现状改善品管圈干预措施。另外选择2021年1月至12月（实施品管圈活动后）在我中心行相同治疗的95例AIS患者，实施问题解决型品管圈干预措施，评价和分析应用效果。结果 实施品管圈活动前后两组患者的年龄、性别、入院时美国国立卫生研究院卒中量表评分、发病至血管再通时间差异均无统计学意义（P均＞0.05）。实施品管圈活动前，药物中断时间为133（110，175）min，序贯治疗时间为367（183，496）min，序贯治疗时间不达标率为45.5%（55/121）。根据柏拉图80/20法则，造成序贯治疗时间不达标的主要原因为等待外出CT检查时间长（36.4%，20/55）、等待CT判读结果时间＞60 min（27.3%，15/55）、护士不知晓患者口服药物时间（20.0%，11/55）。实施品管圈活动后，药物中断时间为38（25，71）min，序贯治疗时间为257（210，298）min，序贯治疗时间不达标率为7.4%（7/95），与实施品管圈活动前比较差异均有统计学意义（P均＜0.001）。实施品管圈活动前后两组分别有3、2例患者在序贯治疗7 d内出现症状性颅内出血，差异无统计学意义（P＞0.05）；两组患者序贯治疗7 d内均无消化道出血发生。结论 应用问题解决型品管圈活动能够规范AIS患者机械取栓术后抗血小板药物给药流程，可以缩短患者药物中断时间，精确口服药物桥接时间，提高患者的用药安全性。 |
| 关键词: 问题解决型品管圈 急性缺血性脑卒中 血管内治疗 抗血小板药物 序贯治疗 替罗非班 |
| DOI：10.16781/j.CN31-2187/R.20230141 |
| 投稿时间：2023-03-27修订日期：2023-10-10 |
| 基金项目:海军军医大学(第二军医大学)第一附属医院"234学科攀峰计划"(2020YZL012). |
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| Application of quality control circle in improving sequential treatment process of antiplatelet agents in patients with acute ischemic stroke after endovascular treatment |
| JIANG Yi,SHEN Fang,WU Xiongfeng,ZHANG Minmin,ZHANG Yongwei,YU Longjuan* |
(Neurovascular Center, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the effect of problem-solving quality control circle (QCC) in regulating the use of antiplatelet agents in patients with acute ischemic stroke (AIS) after endovascular treatment. Methods A QCC was established, and the theme of the activity was “shortening the sequential treatment time of antiplatelet agents in AIS patients after endovascular treatment”. From Jan. 2019 to Dec. 2020 (before the implementation of the QCC), 121 AIS patients who underwent mechanical thrombectomy and bridging sequential treatment of antiplatelet agents in our center were enrolled. The main factors affecting the time of sequential treatment of antiplatelet agents were analyzed, and the QCC intervention measures for improving the current situation were proposed. In addition, 95 AIS patients who received the same treatment in our center from Jan. to Dec. 2021 (after the implementation of the QCC) were enrolled to implement the intervention measures of problem-solving QCC, and the application was evaluated and analyzed. Results There were no significant differences in age, gender, admission National Institutes of Health stroke scale score, or onset-to-recanalization time between the pre- and post-QCC groups (all P＞0.05). Before the implementation of the QCC, the duration of drug interruption was 133 (110, 175) min, the sequential treatment time was 367 (183, 496) min, and the non-compliance rate of sequential treatment time was 45.5% (55/121). According to Plato’s 80/20 rule, the main reasons for the non-compliance of sequential treatment time were long waiting time for computed tomography (CT) examination (36.4%, 20/55), waiting time for interpretation of CT results ＞60 min (27.3%, 15/55), and nurses not knowing the patients’ oral medication time (20.0%, 11/55). After the implementation of the QCC, the duration of drug interruption was 38 (25, 71) min, the sequential treatment time was 257 (210, 298) min, and the non-compliance rate of sequential treatment time was 7.4% (7/95), which were significantly different from those before the implementation of the QCC (all P＜0.001). Before and after the implementation of the QCC, 3 and 2 patients had symptomatic intracranial hemorrhage within 7 d of sequential treatment, and the difference was not significant (P＞0.05); there was no gastrointestinal bleeding within 7 d of sequential treatment. Conclusion The application of problem-solving QCC can standardize the administration process of antiplatelet agents for AIS patients after mechanical thrombectomy, shorten the duration of drug interruption of patients, specify the bridging time of oral drugs, and improve the medication safety of patients. |
| Key words: problem-solving quality control circle acute ischemic stroke endovascular treatment antiplatelet agents sequential therapy tirofiban |
