神经重症医疗质量控制指标

doi:10.3969/j.issn.1673-5765.2023.12.014

摘要/Abstract

摘要： 神经重症是临床神经科学和重症医学的交叉学科，收治罹患神经系统疾病并存在或潜在器官功能障碍的患者。我国神经重症专业成立较晚，神经重症资源设置不均衡，从业人员背景较复杂，其救治理念和诊疗水平存在较大差异。国家神经系统疾病医疗质量控制中心神经重症疾病工作组根据我国神经重症现状，基于现有的循证医学证据，借鉴国内外质量控制指标，组织全国神经重症相关领域的专家，采用改良德尔菲法制定了“神经重症医疗质量控制指标”体系。该指标体系共23项指标，分别为过程性指标、重返类指标和重点病种患者相关指标。神经重症医疗质量控制指标的制定将为我国神经重症医疗质量改进的实施提供首套可供监测的数据指标体系。通过对该指标体系的持续监测可进行纵向和横向的比较。借助这些指标开展有针对性的培训，可提高医护人员对神经重症的认识，规范临床医疗行为，从而提升神经重症医学的医疗质量。

关键词: 神经重症; 医疗质量; 质量控制; 质控指标

Abstract: Neurocritical care is an interdisciplinary discipline at the intersection of clinical neuroscience and critical care medicine that treats patients with neurological diseases and present or potential organ dysfunction. In China, neurocritical care was established late and faces issues like uneven distribution of resources, practitioners with diverse backgrounds, and large differences in treatment concept and the level of diagnosis and treatment. According to the current situation of neurological care in China, based on the existing evidence-based data, drawing on domestic and international quality indicators, the Neurocritical Care Working Group of National Center for Healthcare Quality Management in Neurological Diseases organized experts in neurocritical care to develop the "Quality Control Indicators in Neurocritical Care" using a modified Delphi method. This indicator set includes a total of 23 indicators, categorized as process indicators, readmission indicators, and key disease indicators. The formulation of medical quality control indicator of neurocritical care will provide the first set of data indicator system that can be monitored for the improvement of neurocritical care quality in China. Continuously monitoring of this indicator system will enable longitudinal and cross-sectional comparisons. Targeted training programs based on these indicators will improve the understanding of medical staff on neurological care, standardize clinical practices, and improve the medical quality of neurocritical care.

Key words: Neurocritical care; Quality of medical care; Quality control; Quality control indicator

国家神经系统疾病医疗质量控制中心神经重症疾病工作组. 神经重症医疗质量控制指标[J]. 中国卒中杂志, 2023, 18(12): 1450-1455.

The Neurocritical Care Working Group of National Center for Healthcare Quality Management in Neurological Diseases. Quality Control Indicators in Neurocritical Care[J]. Chinese Journal of Stroke, 2023, 18(12): 1450-1455.

参考文献

[1] TEASDALE G，JENNETT B. Assessment of coma and impaired consciousness. a practical scale[J]. Lancet，1974，2（7872）：81-84.
[2] REITH F C，VAN DEN BRANDE R，SYNNOT A，et al. The reliability of the Glasgow coma scale：a systematic review[J]. Intensive Care Med，2016，42（1）：3-15.
[3] HAWRYLUK G W J，CITERIO G，HUTCHINSON P，et al. Intracranial pressure：current perspectives on physiology and monitoring[J]. Intensive Care Med，2022，48（10）：1471-1481.
[4] ANNANE D，OUANES-BESBES L，DE BACKER D，et al. A global perspective on vasoactive agents in shock[J]. Intensive Care Med，2018，44（6）：833-846.
[5] CECCONI M，DE BACKER D，ANTONELLI M，et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine[J]. Intensive Care Med，2014，40（12）：1795-1815.
[6] CHANGA A R，CZEISLER B M，LORD A S. Management of elevated intracranial pressure：a review[J]. Curr Neurol Neurosci Rep，2019，19（12）：99.
[7] ODDO M，POOLE D，HELBOK R，et al. Fluid therapy in neurointensive care patients：ESICM consensus and clinical practice recommendations[J]. Intensive Care Med，2018，44（4）：449-463.
[8] RAIMANN J G，TZAMALOUKAS A H，LEVIN N W，et al. Osmotic pressure in clinical medicine with an emphasis on dialysis[J]. Semin Dial，2017，30（1）：69-79.
[9] MARRA A，ELY E W，PANDHARIPANDE P P，et al. The ABCDEF bundle in critical care[J]. Crit Care Clin，2017，33（2）：225-243.
[10] MANFORD M. Recent advances in epilepsy[J]. J Neurol，2017，264（8）：1811-1824.
[11] BANOCZI W. ICU-cEEG monitoring[J]. Neurodiagn J，2020，60（4）：231-271.
[12] DEXTER A M，SCOTT J B. Airway management and ventilator-associated events[J]. Respir Care，2019，64（8）：986-993.
[13] TOBIN M，MANTHOUS C. Mechanical ventilation[J]. Am J Respir Crit Care Med，2017，196（2）：P3-p4.
[14] GIOVANE R A，LAVENDER P D. Central nervous system infections[J]. Prim Care，2018，45（3）：505-518.
[15] SEPTIMUS E J. Antimicrobial resistance：an antimicrobial/diagnostic stewardship and infection prevention approach[J]. Med Clin North Am，2018，102（5）：819-829.
[16] 中华医学会重症医学分会. 呼吸机相关性肺炎诊断、预防和治疗指南（2013）[J]. 中华内科杂志，2013，52（6）：524-543.
Chinese Society of Critical Care Medicine. Guidelines for diagnosis，prevention，and treatment of ventilator-associated pneumonia（2013）[J]. Chin J Intern Med，2013，52（6）：524-543.
[17] RUPP M E，KARNATAK R. Intravascular catheter-related bloodstream infections[J]. Infect Dis Clin North Am，2018，32（4）：765-787.
[18] SAMPATHKUMAR P. Reducing catheter-associated urinary tract infections in the ICU[J]. Curr Opin Crit Care，2017，23（5）：372-377.
[19] BOLES J M，BION J，CONNORS A，et al. Weaning from mechanical ventilation[J]. Eur Respir J，2007，29（5）：1033-1056.
[20] PURKAYASTHA S，SOROND F. Transcranial Doppler ultrasound：technique and application[J]. Semin Neurol，2012，32（4）：411-420.
[21] KOTFIS K，MARRA A，ELY E W. ICU delirium-a diagnostic and therapeutic challenge in the intensive care unit[J]. Anaesthesiol Intensive Ther，2018，50（2）：160-167.
[22] CLAGETT G P，ANDERSON F A，LEVINE M N，et al. Prevention of venous thromboembolism
[J/OL]. Chest，1992，102（4 Suppl）：391s-407s
[2023-04-23]. https://doi.org/10.1378/chest.102.4_supplement.391s.
[23] GOULD M K，GARCIA D A，WREN S M，et al. Prevention of VTE in nonorthopedic surgical patients：antithrombotic therapy and prevention of thrombosis，9th ed：American College of Chest Physicians evidence-based clinical practice guidelines[J/OL]. Chest，2012，141（2 Suppl）：e227S-e277S[2023-04-23]. https://doi.org/10.1378/chest.11-2297.
[24] ROGERS S O，KILARU R K，HOSOKAWA P，et al. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery：results from the patient safety in surgery study[J]. J Am Coll Surg，2007，204（6）：1211-1221.
[25] KAHN S R，LIM W，DUNN A S，et al. Prevention of VTE in nonsurgical patients：antithrombotic therapy and prevention of thrombosis，9th ed：American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J/OL]. Chest，2012，141（2 Suppl）：e195S-e226S[2023-04-23]. https://linkinghub.elsevier.com/retrieve/pii/S001236921260124X.