贵州医科大学学报

2018, v.43;No.208(01) 57-60

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绿色通道流程的优化在静脉溶栓治疗急性缺血性脑卒中的价值
Application Value of Green Channel Optimization in the Treatment of Acute Ischemic Stroke with Intravenous Thrombolysis

樊丹丹;霍康;屈秋民;高烨;
FAN Dandan;HUO Kang;QU Qiumin;GAO Ye;Emergency Department,the First Affiliated Hospital of Xi'an Jiaotong University;

摘要(Abstract):

目的:探讨急诊科绿色通道流程的优化在静脉溶栓治疗急性缺血性脑卒中(AIS)中的应用价值。方法:选取2012年01月设立卒中中心绿色通道以来至2017年05月收治的使用阿替普酶(rt PA)静脉溶栓的AIS患者101例,将流程优化前设为对照组共56例患者(2012年01月~2015年12月),流程优化后设为优化组共45例患者(2016年01月~2017年05月);比较两组患者从发病到急诊时间、发病到溶栓时间、就诊到CT时间、就诊到化验时间、拿到化验结果时间、就诊到心电图时间、会诊到达时间、谈话时间及就诊到静脉溶栓时间(DNT),比较两组患者静脉使用rt PA溶栓神经功能缺损程度评分(△NIHSS)。结果:两组患者从就诊到CT时间、就诊到化验时间、拿到化验结果时间、就诊到心电图时间、会诊到达时间、谈话时间及DNT比较,优化组短于对照组,差异有统计学意义(P<0.05);从发病到急诊的时间优化组较对照组延长,差异有统计学意义(P<0.05);两组患者在溶栓后出血转化、住院期间死亡率比较差异无统计学意义(P>0.05);优化组住院时间短于对照组,差异有统计学意义(P<0.05);两组间△NIHSS相比,差异有统计学意义(P<0.05),优化组溶栓24 h显效率和有效率高于对照组,无效率低于对照组,差异有统计学意义(P<0.05)。结论:急诊脑卒中中心绿色通道流程的优化可以缩短DNT时间,提高静脉溶栓百分比,缩短住院时间及改善患者预后。
Objective: To investigate the application value of strengthening the green channel in the treatment of acute ischemic stroke with intravenous thrombolysis. Methods: A total of 101 patients diagnosed acute ischemic stroke( AIS) were selected with recombinant human tissue plasminogen activator( rt PA) from January 2012 to May 2017 since the establishment of stroke center; 56 patients as group A( from January 2012 to December 2015),45 patients as group B( from January 2016 to May2017); comparing the following factors: time of onset to emergency room,time of onset to rt PA,time of diagnosing to CT,time of diagnosing to drug tests,time of acquiring test report,time of diagnosing to ECG,time of consultation,time of conversation and DNT( door to needle time),comparing NIHSS of both groups adopting intravenous rt PA. Results: There were significant differences( P < 0. 05) in time of diagnosing to CT,time of diagnosing to drug tests,time of acquiring test report,time of diagnosing to ECG,time of consultation,time of conversation and DNT( door to needle time),as Group B is shorter than Group A. Comparing the onset time to ER room time,Group B is prolonged than Group A,differences were statistically significant( P < 0. 05); comparing both groups hemorrhagic transformation after rt PA and mortality during hospitalized time,results showed no statistical difference( P > 0. 05);hospitalized time of Group B is shorter than Group A,differences were statistically significant( P <0. 05); comparing NIHSS of both groups,differences were statistically significant( P < 0. 05); rt PA24 hr marked improvement rate of Group B is higher than that of Group A,inefficiency rate is lower than Group A,differences were statistically significant( P < 0. 05). Conclusion: Strengthening the green channel in the Emergency Room of the Stroke Center can shorten DNT,increase the rate of intravenous thrombolysis,shorten the days of hospitalization,improve prognosis.

关键词(KeyWords): 脑血管障碍;卒中;静脉;治疗;预后
cerebrovascular disorder;stroke;vein;therapy;prognosis

Abstract:

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基金项目(Foundation): 十二五国家科技支撑计划资助项目(2011BAI08B05)

作者(Author): 樊丹丹;霍康;屈秋民;高烨;
FAN Dandan;HUO Kang;QU Qiumin;GAO Ye;Emergency Department,the First Affiliated Hospital of Xi'an Jiaotong University;

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DOI: 10.19367/j.cnki.1000-2707.2018.01.013

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