| Objective1.Based on the theory of process reengineering,an optimal process plan for thrombolysis in patients with acute ischemic stroke was constructed.2.The optimized process was applied to a Grade III,Grade A general hospital in Yiyang City to evaluate its application effect on thrombolytic treatment for ischemic stroke patients.MethodsBased on the theory of process reengineering,the literature review and expert meeting method were used to optimize the existing nursing plan for intravenous thrombolysis in acute ischemic stroke.The 294 patients with acute ischemic stroke thrombolytic therapy in a tertiary general hospital in Yiyang City were randomly divided into a control group(155 cases)and an intervention group(139 cases),and the general baseline data,the US National Institutes of Health Stroke Scale(National Institute of Health Stroke Scale,NIHSS)score,the mortality rate and emergency thrombolysis efficiency,first aid process execution time,the time of beginning to dissolve admission,Door-to-Needle Time(DNT),the Modified Rankin Scale(m RS)score and complications were compared between the two groups before and after intervention.Using SPSS21.0 statistical software to analyze the data.measurement data were expressed as mean ± standard deviation(x±s),data conforming to normal distribution and homogeneity of variance were analyzed by t test;if not,the rank sum test was used.Counting data was expressed by frequency and composition ratio,and analyzed by 2 test or Fisher exact probability method.It was indicated that p<0.05 was statistically significant.Results(1)Before intervention,there was no significant difference in the score of NIHSS before thrombolysis between the control group and the intervention group(p>0.05),After intervention,the score of NIHSS at 24 hours after thrombolysis in the intervention group was significantly lower than the control group(p<0.05),When discharge,compared with the control group,the score of NIHSS in the intervention group was lower,and the difference was statistically significant(p<0.05).(2)After intervention,there was no significant difference in the emergency mortality between the intervention group and the control group;The total effective rate of thrombolysis in the intervention group was significantly higher than the control group(p<0.05).(3)After intervention,except for the field treatment time,,important time nodes such as vehicle dispatching time,driving time,EMS response time,on-site treatment time,time from reception to sampling,time from admission to CT examination,time from admission to CT report,time from admission to thrombolysis,time from onset to admission,time from onset to thrombolysis,in the intervention group was significantly lower than the control group after the intervention.Compared with the other time nodes,the intervention group spent less time than the control group,the difference was statistically significant(p< 0.01).(4)There were significant differences in the ratio of DNT<45min and DNT<60min between the two groups(p<0.01).(5)After thrombolytic therapy for 3 months in two groups of patients,the score of Mrs in the intervention group was higher than the control group(62.59% vs 41.29%,p<0.01)by X2 test analysis,the score of Mrs in the intervention group was lower than the control group(p<0.01)by T test analysis.(6)The occurrence probability of symptomatic cerebral hemorrhage and recurrent infarction within 7 days after thrombolysis,the control group was higher than the intervention group,and the difference was statistically significant(p<0.05).The mortality in the control group was higher than the intervention group,but the difference was not statistically significant(p>0.05).Conclusion(1)The application of thrombolytic rescue plan for patients with acute ischemic stroke based on process reengineering theory,effectively narrows the execution time of important nodes in the process of thrombolytic treatment,promotes the recovery of neurological function of patients after stroke,reduces the occurrence of symptomatic cerebral hemorrhage and recurrent infarction after thrombolysis,and improves the success rate of thrombolysis.(2)The thrombolytic rescue plan for patients with acute ischemic stroke under the mode of continuous quality improvement provides the basis and guidance for the formulation of regional collaborative treatment standards for the stroke,helps the construction of regional collaborative treatment network system for the stroke and the construction of hospital stroke center,and supplements the accessibility of the current construction standards for stroke center.Additionaly,it provides help for the construction of regional cooperative treatment network system and hospital stroke center. |
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