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目的探讨胸痛中心成立后,建立持续改进质量控制机制对急性ST段抬高型心肌梗死(STEMI)患者急诊救治效率的影响。方法采用回顾性研究的方法,比较胸痛中心工作人员系统培训前1个月和培训后1个月相关理论知识考核成绩的差异。并将胸痛中心成立后流程改进前(2015年5月-8月)收治的STEMI患者设为A组(n=70),流程改进后(2015年9月-12月)收治的STEMI患者作为B组(n=55),比较两组患者进急诊科大门到挂号时间、首次医嘱时间、急诊停留时间、患者到达急诊科大门至球囊扩张(D2B)时间等指标的差异。结果胸痛中心工作人员培训前后理论成绩分别为(69.89±6.34)、(87.09±4.39)分,差异有统计学意义(P<0.05)。A、B两组患者的时间指标均采用中位数和四分位数表示,其中两组患者进急诊科大门到挂号的时间分别为6.0(0.0,11.0)、1.0(0.0,3.0)min,首次医嘱时间分别为12.8(9.0,18.0)、5.0(3.0,9.0)min,急诊停留时间分别为54.0(44.0,77.0)、33.0(20.0,61.0)min,D2B时间分别为107.5(89.0,130.0)、79.0(63.0、108.0)min,差异均有统计学意义(P<0.05)。结论胸痛中心成立后在运行中不断总结经验,建立长效培训机制,根据医院临床工作实际情况持续改进并优化救治流程,使急性STEMI患者在急诊的停留时间明显缩短,为STEMI患者赢得宝贵的抢救时间。
Objective To investigate the impact of continuous improvement of quality control mechanism on the emergency treatment of patients with acute ST-segment elevation myocardial infarction (STEMI) after the establishment of chest pain center. Methods A retrospective study was conducted to compare the difference between the assessment results of the relevant theoretical knowledge in the 1 month before training and one month after training in the system of chest pain center staff. The patients with STEMI who were admitted to the center of chest pain before the procedure improvement (May-August 2015) were enrolled in group A (n = 70). After the procedure was improved (September-December 2015), STEMI patients were treated as B (N = 55). The differences between the two groups in entering the emergency department door to the registration time, the first doctor’s advice time, the emergency stay time, the time from the patient’s arrival at the emergency department to the time of balloon dilation (D2B) were compared. Results The theoretical scores of chest pain center staff before and after training were (69.89 ± 6.34) and (87.09 ± 4.39) points respectively, the difference was statistically significant (P <0.05). The time indexes of group A and group B were expressed as median and quartile, and the time between entry of emergency department and registration was 6.0 (0.0, 11.0), 1.0 (0.0, 3.0) min, The first doctor’s advice time was 12.8 (9.0,18.0), 5.0 (3.0,9.0) min, the emergency stay time was 54.0 (44.0,77.0), 33.0 (20.0,61.0) min and the D2B time was 107.5 (89.0,130.0) , 79.0 (63.0,108.0) min, the differences were statistically significant (P <0.05). Conclusion After the establishment of the center of chest pain, we continuously sum up experience during the operation and set up a long-term training mechanism. According to the actual situation of the hospital, we continuously improve and optimize the treatment process so that the stay time of patients with acute STEMI in emergency room is significantly shortened, thus earning valuable rescue for STEMI patients time.