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[肺栓塞反应小组对急性肺栓塞患者护理质量及临床结局的影响]

[Effects of pulmonary embolism response team on the quality of care and clinical outcomes in patients with acute pulmonary embolism].

作者信息

Liang Y, Wang X, Lin Y, Zuo H J, Miu H T, Nie S P

机构信息

Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Jul 24;52(7):806-813. doi: 10.3760/cma.j.cn112148-20231022-00362.

Abstract

To evaluate the effects of pulmonary embolism response team (PERT) on the quality of care and clinical outcomes in patients with acute pulmonary embolism. This was a single-center retrospective cohort study. Patients with acute pulmonary embolism treated in Beijing Anzhen Hospital Affiliated to Capital Medical University from July 5, 2016 to July 4, 2018 were enrolled. Patients with acute pulmonary embolism who had traditional care from July 5, 2016 to July 4, 2017 (before the implementation of PERT) were classified as PERT pre-intervention group. Patients with acute pulmonary embolism who started PERT care from July 5, 2017 to July 4, 2018 were divided into the PERT intervention group. The diagnosis and treatment information of patients was collected through the electronic medical record system, and the quality of care (time from visit to hospitalization, time from hospitalization to anticoagulation initiation, time from visit to definitive diagnosis, total hospital stay, time in intensive care unit (ICU), hospitalization cost) and clinical outcomes (in-hospital mortality and incidence of bleeding) were compared between the two groups. A total of 210 patients with acute pulmonary embolism, aged (63.3±13.7) years old, with 102 (48.6%) female patients were included. There were 108 cases in PERT pre-intervention group and 102 cases in PERT intervention group. (1) Quality of diagnosis and treatment: there was a statistical significance between the two groups in the distribution of time from diagnosis to definitive diagnosis (0.002). Among them, the rate of completion of diagnosis within 24 hours after PERT intervention was higher than that before PERT intervention (80.4% (45/56) vs. 50.0% (34/68), 0.001). The time from treatment to hospitalization was shorter than that before PERT intervention (180.0 (60.0, 645.0) min vs. 900.0 (298.0, 1 806.5) min, 0.001). The total length of hospital stay was less than that before PERT intervention (12 (10, 14) d vs. 14 (11, 16) d, 0.001). There was no statistical significance in the time from hospitalization to anticoagulant therapy, the length of ICU stay and hospitalization cost between the two groups (all 0.05). (2) Clinical outcomes during hospitalization: There was no statistical significance in the incidence of hemorrhage and mortality between the two groups during hospitalization (both 0.05). PERT has improved the efficiency of diagnosis and treatment of patients with acute pulmonary embolism and significantly shortened the total hospital stay, but its impact on clinical outcomes still needs further study.

摘要

评估肺栓塞反应小组(PERT)对急性肺栓塞患者护理质量及临床结局的影响。这是一项单中心回顾性队列研究。纳入2016年7月5日至2018年7月4日在首都医科大学附属北京安贞医院接受治疗的急性肺栓塞患者。2016年7月5日至2017年7月4日(PERT实施前)接受传统护理的急性肺栓塞患者被分类为PERT干预前组。2017年7月5日至2018年7月4日开始接受PERT护理的急性肺栓塞患者被分为PERT干预组。通过电子病历系统收集患者的诊断和治疗信息,并比较两组之间的护理质量(就诊至住院时间、住院至开始抗凝时间、就诊至明确诊断时间、总住院时间、重症监护病房(ICU)停留时间、住院费用)和临床结局(院内死亡率和出血发生率)。共纳入210例急性肺栓塞患者,年龄(63.3±13.7)岁,女性患者102例(48.6%)。PERT干预前组108例,PERT干预组102例。(1)诊断和治疗质量:两组在诊断至明确诊断时间的分布上存在统计学意义(0.002)。其中,PERT干预后24小时内完成诊断的比例高于PERT干预前(80.4%(45/56)对50.0%(34/68),0.001)。治疗至住院时间短于PERT干预前(180.0(60.0,645.0)分钟对900.0(298.0,1806.5)分钟,0.001)。总住院时间少于PERT干预前(12(10,14)天对14(11,16)天,0.001)。两组在住院至抗凝治疗时间以及ICU停留时间和住院费用方面无统计学意义(均P>0.05)。(2)住院期间的临床结局:两组住院期间出血发生率和死亡率无统计学意义(均P>0.05)。PERT提高了急性肺栓塞患者的诊断和治疗效率,并显著缩短了总住院时间,但其对临床结局的影响仍需进一步研究。

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