SOP在ASTEMI患者绕行急诊行PCI手术的应用及效果研究

董文哲

【摘要】 目的：探究標准作业程序（SOP）在ST段抬高型急性心肌梗死（ASTEMI）患者绕行急诊行冠状动脉介入（PCI）手术的应用效果。方法：选取2019年1月-2020年6月本院收治的ASTEMI患者60例，其中2019年1-7月30例ASTEMI患者为对照组，行常规急诊PCI手术;2019年8月-2020年6月30例ASTEMI患者为观察组，SOP下绕行急诊行PCI手术。比较两组救治时间[发病到首次医疗接触（S-to-FMC）时间、门-球时间（D-to-B）、发病到球囊扩张时间（S-to-B）、住院时间]、D-to-B达标率、局部血肿发生率、护理工作满意度。结果：观察组S-to-FMC、D-to-B、S-to-B、住院时间均短于对照组（P<0.05）。观察组D-to-B达标率为96.67%（29/30），高于对照组的70.00%（21/30），局部血肿发生率为6.67%（2/30），低于对照组的33.33%（10/30），差异均有统计学意义（P<0.05）;观察组移情性、可靠性、反应性、有形性、保证性评分均高于对照组（P<0.05）。结论：SOP可有效缩短患者救治时间，提升护理工作满意度，是ASTEMI患者绕行急诊行PCI手术的一项优质、高效作业流程指南。

【关键词】 急诊 ST段抬高型急性心肌梗死 救治时间 作业流程 满意度 门-球时间

Application and Effect of SOP in Bypass Emergency Department PCI Surgery in Patients with ASTEMI/DONG Wenzhe. //Medical Innovation of China， 2021， 18（30）： -108

[Abstract] Objective： To explore the application effect of standard operating procedures （SOP） in bypass emergency department percutaneous coronary intervention （PCI） surgery in patients with acute ST segment elevation myocardial infarction （ASTEMI）. Method： A total of 60 ASTEMI patients admitted to our hospital from January 2019 to June 2020 were selected， 30 ASTEMI patients from January 2019 to July 2019 were selected as the control group and underwent conventional emergency PCI， and 30 ASTEMI patients from August 2019 to June 2020 were selected as the observation group， PCI surgery was performed by bypass emergency department under SOP. The treatment time [time from onset to first medical contact （S-to-FMC）， door-to-balloon time （D-to-B）， time from onset to balloon expansion （S-to-B）， hospital stay]， D-to-B compliance rate， local hematoma incidence， nursing job satisfaction of two groups were compared. Result： The S-to-FMC， D-to-B， S-to-B and hospital stay of the observation group were shorter than those of the control group （P<0.05）. The D-to-B compliance rate of the observation group was 96.67% （29/30）， which was higher than 70.00% （21/30） of the control group， the incidence of local hematoma was 6.67% （2/30）， which was lower than 33.33% （10/30） of the control group， the differences were statistcally significant （P<0.05）. The scores of empathy， reliability， reactivity， tangibility， and assurance of the observation group were higher than those of the control group （P<0.05）. Conclusion： SOP can effectively shorten the treatment time of patients and improve the satisfaction of nursing work. It is a high-quality and efficient operation process guide for ASTEMI patients to bypass emergency PCI surgery.

[Key words] Emergency department Acute ST segment elevation myocardial infarction Treatment time Work flow Satisfaction Door-to-balloon time

First-author’s address： Pingxiang People’s Hospital， Pingxiang 337000， China

doi：10.3969/j.issn.1674-4985.2021.30.025

ST段抬高型急性心肌梗死（acute ST segment elevation myocardial infarction，ASTEMI）為典型缺血性胸痛，早期再灌注是救治成功的关键。据统计，1 h内成功再灌注患者病死率仅为1.6%，而6 h内行再灌注治疗患者病死率增加至6%[1]。研究发现，绕行急诊可显著缩短就诊手术救治时间，有助于节约时间，改善预后[2]。但绕行急诊行冠状动脉介入（PCI）术对抢救环节及介入团队要求严格，绕行过程中患者受多种不确定因素影响，易延长闭塞血管开通时间，可能影响早期再灌注效果，故临床工作中需对绕行环节进行规范与整理，建立标准化作业流程[3-4]。王莉莉等[5]研究的标准作业程序（SOP）乳腺手册的应用，以护理过程为基础建立质量管理体系，保证同质化护理，使乳腺专科护理品质得到显著提升，但SOP在规范急诊ASTEMI患者绕行急诊行PCI手术应用鲜有报道。……