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目的分析总结心脏大血管外科检验危急值的历史数据,为持续改进危急值的处理流程,提高护士的临床护理水平提供依据。方法对2013年4月—2014年4月入住心脏大血管外科的236例患者发生的危急值项目进行回顾性分析。收集整理患者的一般资料,包括危急值类型、数值、分布情况、临床处理时间,以及与危急值相关的并发症。结果纳入患者185例,其中报告危急值208例次,包括血钾99例次(47.60%),血糖13例次(6.25%),血钠11例次(5.29%),肌钙蛋白13例次(6.25%),其他72例次(34.62%);与心脏大血管外科密切相关的危急值有136例次,其中临床处理时间≤15 min 60例次,经再次采集标本复查后确定为假危急值16例次,根据患者病情无需处理11例次(均为肌钙蛋白)。185例患者发生与危急值相关的并发症共27例次,其中与血钾异常相关的心律失常23例次,与血钠异常相关的肌力异常2例次,低血糖反应2例;在对患者危急值进行处理后,相关并发症均消失且未再次出现。结论医护人员应重视危急值,提高对危急值的处理能力,同时应建立完善的临床危急值管理制度及记录处理流程。对于心脏大血管外科护理人员而言,应掌握血钾、血糖、血钠及肌钙蛋白等与专科密切相关的危急值临床知识,以保证能及时有效地实施危急值应对措施,更加准确地处理危急值,实现医疗护理质量的持续改进和提高。
OBJECTIVE: To analyze and summarize the historical data of critical value of cardiac major vascular surgery in order to provide the basis for continually improving the treatment process of critical value and improving the level of clinical nursing for nurses. Methods A retrospective analysis was performed on the critical value items of 236 patients admitted to Cardiac Surgery from April 2013 to April 2014. General information collected, including critical types, values, distribution, clinical treatment time, and complications associated with critical values. Results A total of 185 patients were enrolled in this study. Among them, 208 cases were reported as critical value, including 99 cases of potassium (47.60%), 13 cases of blood glucose (6.25%), 11 cases of hyponatremia (5.29%), 13 cases of troponin (6.25%), the other 72 cases (34.62%). There were 136 cases of critical value associated with major macrovascular surgery, of which 60 cases were treated for less than 15 minutes and were determined to be false after re-sampling The value of 16 cases, according to the patient’s condition without treatment of 11 cases (both troponin). A total of 271 cases of complications related to critical value occurred in 185 patients, of which 23 were arrhythmia related to serum potassium abnormality, 2 were muscle abnormalities related to serum sodium abnormality and 2 were hypoglycemic reactions. Patients with critical values for treatment, the relevant complications have disappeared and did not appear again. Conclusion Medical staff should pay attention to the critical value and improve the ability to deal with the critical value. At the same time, establish a sound clinical critical value management system and record processing flow. For cardiac vascular care nurses, should grasp the critical value of serum potassium, blood glucose, serum sodium and troponin closely related to the critical clinical knowledge to ensure timely and effective implementation of critical value measures to deal with more accurately Critical value, to achieve continuous improvement and improvement of the quality of medical care.