- 期刊
運用實證醫學改善急性缺血腦中風靜脈血栓溶劑施打成效
Improvement of Intravenous Thrombolytic Treatment in Acute Ischemic Stroke Patients with Evidence-based Medicine Approach
摘要
目的：探討運用實證醫學知識轉譯方式改善靜脈血栓溶劑施打成效。方法：本研究對象為經急診求治之急性缺血腦中風患者，統計接受靜脈血栓溶劑治療者之各項品質指標，以2012年至2014年為品質改善方案介入前期，品質改善方案介入後的2015年為介入成效評估期。結果：本院自2012成立腦中風團隊運作統計資料顯示，品質改善方案介入前3年共有6名患者接受靜脈血栓溶劑治療，平均door to needle需花費88分，而方案介入後縮短door to needle時間達42分鐘，分析可能的原因有(1)檢傷分類護理師以資深者較易早期發現腦中風病患；(2)不典型神經學症狀，可能是影響團隊判別是否為腦中風患者的最重要干擾因素。結論：透過實證醫學及臨床轉譯的方式，從臨床轉譯之注意到(aware)、接受(accepted)、可行(applicable)、有能力做(able)、開始做(acted on)、認同(agreed)、養成習慣(adhered to)的“7A＂實踐知識過程，可有效的縮短急性缺血腦中風患者血栓溶解劑使用door to needle 的時間。
並列摘要
Objectives: Assessment of the effectiveness of improving intravenous tissue plasminogen activator (rt-PA) thrombolysis door to needle time by evidencebased medicine and knowledge translation strategies. Methods: This study adopted a quality-improvement program. Medical records of patients with acute ischemic stroke who sought treatment via emergency room and received intravenous rt-PA thrombolysis t reatment between 2012 and 2014 (basel ine period) were reviewed. A series of interventions to reduce treatment delays were implemented and the outcomes were assessed in 2015. Results: A total of 6 patients were treated between January 2012 and December 2014, with an average of door to needle thrombolysis time of 88 minutes. After the quality improvement program intervention, 2 acute ischemic stroke patients received intravenous rt-PA were recorded. The average of door to needle thrombolysis time was reduced to 46 minutes. The possible causes of improvement including: (1) the senior triage nurse was the key factor to early identify stroke patients and activated the stroke call; (2) the atypical neurological presentation was the mostly important cause of delay identification. Conclusion: With the evidence-based and knowledge translation ＂7A＂ (aware, accepted, applicable, able, acted on, agreed, and adhered to) strategies it is possible to shorten the door to needle thrombolysis time.
延伸閱讀
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