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1.复旦大学附属华东医院神经内科,上海 200040
2.复旦大学护理学院,上海 200032
赵丽蓉,Email:13701755277@163.com, 研究方向:心脑血管临床护理、慢病管理。
张颖影,Email:easonl411@163.com。
收稿:2022-04-15,
纸质出版:2022-07-28
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赵丽蓉,张颖影,朱真,等.BTS质量改进模式在缺血性脑卒中患者中的应用效果评价[J].重庆医科大学学报,2022,47(7):834-840.
Zhao Lirong,Zhang Yingying,Zhu Zhen,et al.Effect evaluation of BTS quality improvement model in patients with ischemic stroke[J].Journal of Chongqing Medical University,2022,47(7):834-840.
赵丽蓉,张颖影,朱真,等.BTS质量改进模式在缺血性脑卒中患者中的应用效果评价[J].重庆医科大学学报,2022,47(7):834-840. DOI: 10.13406/j.cnki.cyxb.003068.
Zhao Lirong,Zhang Yingying,Zhu Zhen,et al.Effect evaluation of BTS quality improvement model in patients with ischemic stroke[J].Journal of Chongqing Medical University,2022,47(7):834-840. DOI: 10.13406/j.cnki.cyxb.003068.
目的
2
探讨基于突破性系列(breakthrough series,BTS)质量改进模式在缺血性脑卒中患者中的应用效果。
方法
2
采用非同期前后对照的研究方法,将2020年6月至9月未采用BTS质量改进模式56例患者作为对照组;将2021年3月至7月采用BTS质量改进模式的56例患者作为观察组。比较实施前后2组患者美国国立卫生院脑卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、Barthel指数、压疮发生率、住院天数、改良Rankin量表(modified Rankin Scale,mRS)评分、营养指标及满意度的情况。
结果
2
应用BTS质量改进模式后,观察组NIHSS评分明显低
于对照组,差异有统计学差异(
P
<
0.05);观察组mRS评分(2.31±0.43)低于对照组(4.68±0.85),差异有统计学意义(
P
<
0.05);2组营养指标及满意度差异均有统计学意义(
P
<
0.05)。
结论
2
BTS质量改进模型的应用能够有效提升缺血性脑卒中患者护理质量,促进患者神经功能恢复,改善患者预后情况。
Objective
2
To explore the application effect of breakthrough series(BTS) quality improvement model on patients with ischemic stroke.
Methods
2
A total of 56 patients who did not take BTS quality improvement model from June 2020 to September 2020 were selected as the control group; 56 patients who took BTS quality improvement model from March 2021 to July 2021 were selected as the observation group. The scores of National Institutes of Health Stroke Scale(NIHSS),the Barthel index of ADL,pressure ulcer prevalence,length of stay,modified Rankin Scale(mRS),nutritional indexes and satisfaction of the two groups were compared before and after the implementation of the model.
Results
2
After applying BTS quality improvement model,the NIHSS score of the observation group was significantly lower than that of the control group(
P
<
0.05);the mRS score of the observation group[(2.31 ± 0.43) points] was significantly lower than that of the control group[(4.68 ± 0.85)points](
P
<
0.05);there were significant differences in nutritional indexes and satisfaction between the two groups(
P
<
0.05).
Conclusion
2
The application of BTS quality improvement model can effectively improve the nursing quality of patients with ischemic stroke and promote the recovery of neurological function,thus improving the prognosis of patients.
Chen JJ , Yao M , Zhao YH , et al . Use of acupuncture to treat cerebral infarction in the last 10 years:a Scopus-based literature analysis [J ] . Neural Regen Res , 2012 , 7 ( 36 ): 2944 - 2951 .
Krueger H , Koot J , Hall RE , et al . Prevalence of individuals experiencing the effects of stroke in Canada:trends and projections [J ] . Stroke , 2015 , 46 ( 8 ): 2226 - 2231 .
Catangui EJ . Role of the nurse in the hyperacute care and management of patients following stroke [J ] . Nurs Stand , 2021 , 36 ( 1 ): 70 - 75 .
Caplan LR . Intracranial branch atheromatous disease:a neglected,understudied,and underused concept [J ] . Neurology , 1989 , 39 ( 9 ): 1246 - 1250 .
Deen T , Terna T , Kim E , et al . The impact of stroke nurse navigation on patient compliance postdischarge [J ] . Rehabil Nurs , 2018 , 43 ( 2 ): 65 - 72 .
Rega ML , De Vito C , Ruberto M , et al . The nurse led of stroke patient after discharge from hospital. A systematic review and GRADE [J ] . Prof Inferm , 2020 , 73 ( 4 ): 278 - 287 .
Brom H , Carthon JMB , Sloane D , et al . Better nurse work environments associated with fewer readmissions and shorter length of stay among adults with ischemic stroke:a cross-sectional analysis of United States hospitals [J ] . Res Nurs Health , 2021 , 44 ( 3 ): 525 - 533 .
Langhorne P , Bernhardt J , Kwakkel G . Stroke rehabilitation [J ] . Lancet , 2011 , 377 ( 9778 ): 1693 - 1702 .
吴亚哲 , 陈伟伟 . 中国脑卒中流行概况 [J ] . 心脑血管病防治 , 2016 , 16 ( 6 ): 410 - 414 .
Wu YZ , Chen WW . Epidemiological survey of stroke in China [J ] . Prev Treat Cardio Cereb Vasc Dis , 2016 , 16 ( 6 ): 410 - 414 .
中国急性缺血性脑卒中诊治指南 2018 [J ] . 中华神经科杂志 ,2018, 51 ( 9 ): 666 - 682 .
Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018 [J ] . Chin J Neurol ,2018, 51 ( 9 ): 666 - 682 .
朱康宁 , 贾莉莉 , 杨艳艳 , 等 . 缺血性脑卒中病人分级护理方案的构建 [J ] . 护理研究 , 2021 , 35 ( 3 ): 550 - 553 .
Zhu KN , Jia LL , Yang YY , et al . Construction of graded nursing program for patients with ischemic stroke [J ] . Chin Nurs Res , 2021 , 35 ( 3 ): 550 - 553 .
Wells S , Tamir O , Gray J , et al . Are quality improvement collaboratives effective?A systematic review [J ] . BMJ Qual Saf , 2018 , 27 ( 3 ): 226 - 240 .
Ebert L , Amaya-Jackson L , Markiewicz JM , et al . Use of the breakthrough series collaborative to support broad and sustained use of evidence-based trauma treatment for children in community practice settings [J ] . Adm Policy Ment Health , 2012 , 39 ( 3 ): 187 - 199 .
孙玉娇 , 张 宁 , 陆 熠 , 等 . 基于BTS质量改进模式在围术期高血糖病人管理中的应用 [J ] . 全科护理 , 2020 , 18 ( 8 ): 906 - 911 .
Sun YJ , Zhang N , Lu Y , et al . Application of BTS-based quality improvement model in management of perioperative hyperglycemia patients [J ] . Chin Gen Pract Nurs , 2020 , 18 ( 8 ): 906 - 911 .
胡延秋 , 程 云 , 王银云 , 等 . 成人经鼻胃管喂养临床实践指南的构建 [J ] . 中华护理杂志 , 2016 , 51 ( 2 ): 133 - 141 .
Hu YQ , Cheng Y , Wang YY , et al . Development of clinical practice guideline for nasogastric tube feeding in adult patients [J ] . Chin J Nurs , 2016 , 51 ( 2 ): 133 - 141 .
Kernan WN , Ovbiagele B , Black HR , et al . Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J ] . Stroke , 2014 , 45 ( 7 ): 2160 - 2236 .
黄海侠 , 邹 钒 , 吴卓丽 , 等 . 超早期运动康复对轻中度急性缺血性脑卒中患者功能结局及下肢运动能力的影响 [J ] . 广西医学 , 2020 , 42 ( 18 ): 2349 - 2353 .
Huang HX , Zou F , Wu ZL , et al . Effect of very early mobilization rehabilitation on functional outcomes and lower extremity motor ability in patients with mild to moderate acute ischemic stroke [J ] . Guangxi Med J , 2020 , 42 ( 18 ): 2349 - 2353 .
Khorvash F , Shahnazi H , Saadatnia M , et al . Implementation of home-based health promotion program to improve flow-mediated dilation among patients with subacute stroke [J ] . J Educ Health Promot , 2020 , 9 : 41 .
陈会娜 , 江佳隆 , 刘文秀 , 等 . 缺血性脑卒中患者疾病心理社会适应水平调查 [J ] . 护理学杂志 , 2021 , 36 ( 14 ): 8 - 11 .
Chen HN , Jiang JL , Liu WX , et al . Psychosocial adjustment of ischemic stroke patients [J ] . J Nurs Sci , 2021 , 36 ( 14 ): 8 - 11 .
Towfighi A , Ovbiagele B , Husseini NE , et al . Poststroke depression:a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association [J ] . Stroke , 2017 , 48 ( 2 ): e30 - e43 .
杜 静 , 翁雪云 , 余 红 , 等 . 脑卒中恢复期患者的个性化自我管理干预 [J ] . 护理学杂志 , 2020 , 35 ( 22 ): 28 - 31 .
Du J , Weng XY , Yu H , et al . Individualized self-management intervention for convalescent stroke survivors [J ] . J Nurs Sci , 2020 , 35 ( 22 ): 28 - 31 .
Bruno A , Shah N , Lin C , et al . Improving modified Rankin Scale assessment with a simplified questionnaire [J ] . Stroke , 2010 , 41 ( 5 ): 1048 - 1050 .
Censori B , Camerlingo M , Casto L , et al . Prognostic factors in first-ever stroke in the carotid artery territory seen within 6 hours after onset [J ] . Stroke , 1993 , 24 ( 4 ): 532 - 535 .
Muir KW , Weir CJ , Murray GD , et al . Comparison of neurological scales and scoring systems for acute stroke prognosis [J ] . Stroke , 1996 , 27 ( 10 ): 1817 - 1820 .
Jr Adams HP , Davis PH , Leira EC , et al . Baseline NIH Stroke Scale score strongly predicts outcome after stroke:a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) [J ] . Neurology , 1999 , 53 ( 1 ): 126 - 131 .
Frankel MR , Morgenstern LB , Kwiatkowski T , et al . Predicting prognosis after stroke:a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial [J ] . Neurology , 2000 , 55 ( 7 ): 952 - 959 .
Brott T , Jr Adams HP , Olinger CP , et al . Measurements of acute cerebral infarction:a clinical examination scale [J ] . Stroke , 1989 , 20 ( 7 ): 864 - 870 .
Goldstein LB , Bertels C , Davis JN . Interrater reliability of the NIH stroke scale [J ] . Arch Neurol , 1989 , 46 ( 6 ): 660 - 662 .
Powers WJ , Rabinstein AA , Ackerson T , et al . Guidelines for the early management of patients with acute ischemic stroke:2019 update to the 2018 guidelines for the early management of acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J ] . Stroke , 2019 , 50 ( 12 ): e344 -
e 418 .
de Haan R , Limburg M , Bossuyt P , et al . The clinical meaning of Rankin‘handicap’ grades after stroke [J ] . Stroke , 1995 , 26 ( 11 ): 2027 - 2030 .
Kuklina EV , Callaghan WM . Chronic heart disease and severe obstetric morbidity among hospitalisations for pregnancy in the USA:1995-2006 [J ] . BJOG Int J Obstet Gynaecol , 2011 , 118 ( 3 ): 345 - 352 .
Leifer D , Bravata DM , 3rd Connors JJB , et al . Metrics for measuring quality of care in comprehensive stroke centers:detailed follow-up to Brain Attack Coalition comprehensive stroke center recommendations:a statement for healthcare professionals from the American Heart Association/American Stroke Association [J ] . Stroke , 2011 , 42 ( 3 ): 849 - 877 .
de Melo L , de Abreu MVM , de Oliveira Santos BR , et al . Partnership among hospitals to reduce healthcare associated infections:a quasi-experimental study in Brazilian ICUs [J ] . BMC Infect Dis , 2021 , 21 ( 1 ): 212 .
Asch SM , Baker DW , Keesey JW , et al . Does the collaborative model improve care for chronic heart failure? [J ] . Med Care , 2005 , 43 ( 7 ): 667 - 675 .
Bidassie B , Davies ML , Stark R , et al . VA experience in implementing patient-centered medical home using a breakthrough series collaborative [J ] . J Gen Intern Med , 2014 ,29 Suppl 2 (Suppl 2): S563 - S571.
Ramazanu S , Bautista C , Green T , et al . Challenges and opportunities in stroke nursing research:global views from a panel of nurse researchers [J ] . J Neurosci Nurs , 2022 , 54 ( 3 ): 111 - 115 .
Markus HS . Cerebral perfusion and stroke [J ] . J Neurol Neurosurg Psychiatry , 2004 , 75 ( 3 ): 353 - 361 .
Johnston SC , Nguyen-Huynh MN , Schwarz ME , et al . National Stroke Association guidelines for the management of transient ischemic attacks [J ] . Ann Neurol , 2006 , 60 ( 3 ): 301 - 313 .
Guidelines for management of ischaemic stroke and transient ischaemic attack 2008 [J ] . Cerebrovasc Dis , 2008 , 25 ( 5 ): 457 - 507 .
Kernan WN , Ovbiagele B , Black HR , et al . Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J ] . Stroke , 2014 , 45 ( 7 ): 2160 - 2236 .
Shinohara Y , Yanagihara T , Abe K , et al . II. Cerebral infarction/transient ischemic attack (TIA) [J ] . J Stroke Cerebrovasc Dis , 2011 , 20 ( 4 Suppl ): S31 - S73 .
Jauch EC , Saver JL , Jr Adams HP , et al . Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J ] . Stroke , 2013 , 44 ( 3 ): 870 - 947 .
Asch SM , Kerr EA , Keesey J , et al . Who is at greatest risk for receiving poor-quality health care? [J ] . N Engl J Med , 2006 , 354 ( 11 ): 1147 - 1156 .
Wang WZ , Jiang B , Sun HX , et al . Prevalence,incidence,and mortality of stroke in China:results from a nationwide population-based survey of 480 687 adults [J ] . Circulation , 2017 , 135 ( 8 ): 759 - 771 .
Cramer SC . Repairing the human brain after stroke:I. Mechanisms of spontaneous recovery [J ] . Ann Neurol , 2008 , 63 ( 3 ): 272 - 287 .
周雪珍 , 叶素贞 , 陈传帮 . 肌内效贴治疗急性脑卒中患者吞咽障碍的疗效观察 [J ] . 重庆医学 , 2019 , 48 ( 14 ): 2423 - 2426 .
Zhou XZ , Ye SZ , Chen CB . Therapeutic effect of intramuscular effect on dysphagia in patients with acute stroke [J ] . Chongqing Medicine , 2019 , 48 ( 14 ): 2423 - 2426 .
范明娜 , 常立阳 , 周海芳 , 等 . 脑卒中鼻饲患者围拔胃管期营养护理方案构建 [J ] . 护士进修杂志 , 2022 , 37 ( 4 ): 294 - 298 .
Fan MN , Chang LY , Zhou HF , et al . Construction of nutritional care scheme for patients with stroke and nasal feeding during removing gastric tube [J ] . J Nurses Train , 2022 , 37 ( 4 ): 294 - 298 .
范春江 , 刘庭玉 , 李 刚 , 等 . 肠内营养对缺血性脑卒中患者肠道菌群的影响 [J ] . 中国康复理论与实践 , 2019 , 25 ( 7 ): 822 - 827 .
Fan CJ , Liu TY , Li G , et al . Effect of enteral nutrition on intestinal flora in patients with ischemic stroke [J ] . Chin J Rehabil Theory Pract , 2019 , 25 ( 7 ): 822 - 827 .
Scrivener K , Tourany R , Mcnamara-Holmes M , et al . Feasibility of a nurse-led weekend group exercise program for people after stroke [J ] . Stroke Res Treat , 2017 , 2017 : 1 - 7 .
Lo SHS , Chau JPC . Exploring community-dwelling stroke survivors' experiences of receiving a nurse-led theory-based stroke self-management programme:a qualitative study [J ] . Medicine , 2021 , 100 ( 37 ): e27256 .
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