【摘要】 目的针对动脉瘤性蛛网膜下腔出血救治效率延误的危险因素,探讨单中心颅内破裂动脉瘤救治效能的综合评价模型评分体系的建立。方法课题调研时间为2017年9月至12月。(1)选择问卷专家组成员,由34名专家通过2轮Delphi专家咨询法问卷进行评分。(2)运用模糊评价方法建立综合评价模型及评分标准。综合模型分为一、二级指标,一级指标为团队能力、医疗设备和急救体系三方面评价因素;二级指标是对一级指标的进一步细化,包括颅内责任动脉瘤年治疗量、医院等级、脑血管病团队、导管室、手术室、CT检查设备、CT血管成像设备、院内卒中绿色通道、转院机制、会诊机制、多学科协作诊疗制度的建设等11项评价因子。二级指标的总分值为0～30分。根据综合评价模型及评分获得单中心救治效率等级,包括效率极高(25～30分)、效率较高(18～24分)、效率高(11～17分)、效率较低(5～10分)和效率极低(0～4分)。(3)随机抽取6家医院,对其进行综合评价模型及Delphi专家咨询法问卷评分和排序。(4)专家的积极性以有效问卷的回收率进行评价,回收率越高表明专家的积极性越高。问卷的信度采用克朗巴赫系数(α值)表示,α值为0. 7～0. 8表示具有较好的信度,> 0. 8表示信度非常好;问卷的效度采用KMO系数,KMO值越接近于1表示变量间的相关性越强。结果 (1) Delphi专家咨询法问卷评价结果显示,2轮问卷的有效回收率分别为85. 3%(29/34)、88. 2%(30/34);克朗巴赫系数α分别为为0. 958、0. 969;KMO系数分别为0. 822、0. 843。(2)一级指标中团队能力、医疗设备和急救体系的权重分别为0. 35、0. 32、0. 32。二级指标中脑血管病团队所占权重最大,为0. 105;多学科协作诊疗制度所占权重最小,为0. 081。(3)对随机抽取的1～6家医院进行评分和排序,结果显示,综合评价模型的评分结果分别为26、24、7、15、16、2分,Delphi专家咨询法问卷的评分结果分别为(9. 6±0. 5)、(8. 0±0. 8)、(5. 2±1. 2)、(6. 2±1. 2)、(6. 4±1. 6)、(3. 7±1. 7)分,排序均为1、2、5、4、3、6。结论运用模糊评价方法可建立单中心的颅内破裂动脉瘤救治效能的综合评价模型评分体系,但综合评价模型评分与颅内破裂动脉瘤救治延误的一致性尚须进一步验证。更多还原

【Abstract】 Objective To investigate the establishment of a scoring system of comprehensive evaluation model for treatment efficiency of single-center ruptured intracranial aneurysms aiming at the risk factors for delayed treatment efficiency for aneurysmal subarachnoid hemorrhage. Methods The research time was from September to December 2017.(1) The members of the expert group of choice questionnaire were selected and they were scored by 34 experts through two rounds of Delphi expert consultation questionnaires.(2) Using fuzzy evaluation method to establish comprehensive evaluation model and scoring criteria. The comprehensive models were divided into first level and second level indicators. The first level indicator was three aspects of evaluation factors,including team ability,medical equipment,and first aid system,the second level indicator was a further refinement of the first level indicator,including 11 evaluation factors:annual treatment volume of guilty aneurysms,hospital grade,cerebrovascular disease team,catheter room,operation room,CT examination equipment,CT angiography equipment,green channel of hospital stroke,transfer mechanism,consultation mechanism,and construction of multi-disciplinary collaborative diagnosis and treatment system. The total score of the secondary level indicator was 0-30. According to the comprehensive evaluation model and scores,the single center treatment efficiency grade was obtained,including extremely high efficiency(25-30),higher efficiency(18-24),high efficiency(11-17),lower efficiency(5-10) and extremely low efficiency(0-4).(3) Six hospitals were randomly selected and their comprehensive evaluation models and Delphi expert consultation questionnaires were scored and sorted.(4) The enthusiasm of the experts was evaluated by the recovery rate of the effective questionnaires,the higher the recovery rate,the higher the enthusiasm of experts. The reliability of the questionnaires was expressed by Cronbach’s coefficient(α value),α value 0. 7-0. 8 indicated better reliability,and > 0. 8 indicated very good reliability. The validity of the questionnaires was expressed by KMO coefficient,and the closer the KMO value was to 1,the stronger the correlation between variables. Results(1) The results of the Delphi expert consultation questionnaires showed that the effective recovery rates of the two rounds of questionnaires were 85. 3%(29/34) and88. 2%(30/34) respectively; the Cronbach’ s coefficient α was 0. 958 and 0. 969 respectively,and the KMO coefficient was 0. 822 and 0. 843 respectively.(2) In the primary indicators,the weight coefficient of team ability,medical equipment,and first aid system were 0. 35,0. 32 and 0. 32,respectively. In the secondary indicators,the weight of cerebrovascular disease team was the largest,which was 0. 105. The weight of multi-disciplinary collaborative diagnosis and treatment system was the smallest,which was0. 081.(3) One to 6 hospitals were randomly selected and they were scored and sorted. The results of the comprehensive evaluation model scores were 26,24,7,15,16 and 2,respectively. The results of Delphi expert consultation questionnaires were 9. 6 ± 0. 5,8. 0 ± 0. 8,5. 2 ± 1. 2,6. 2 ± 1. 2,6. 4 ± 1. 6,and 3. 7 ± 1. 7,respectively. The sorts were all 1,2,5,4,3 and 6. Conclusion Fuzzy evaluation method can be used to establish a comprehensive evaluation model score for the treatment efficacy of single-center ruptured intracranial aneurysms,but the consistency between the comprehensive evaluation model score and the treatment delay of ruptured intracranial aneurysms needs to be further validated.更多还原