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;

• 1:西安交通大学第一附属医院急诊科

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:

Keywords:

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;

Email:

DOI: 10.19367/j.cnki.1000-2707.2018.01.013

参考文献(References)：

• [1]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
• [2]中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志,2015,10(7):590-606.
• [3]中华医学会神经病学分会,中华医学会神经病学分会神经血管介入协作组,急性缺血性脑卒中介入诊疗指南撰写组.中国急性缺血性脑卒中早期血管内介入诊疗指南[J].中华神经科杂志,2015,48(5):356-361.
• [4]HACKE W,DONNAN G,FIESCHI C,et al.ATLANTIS trials investigators,and the ECASS trials investigators,and the NINDS rt-PA study group investigators.association of outcome with early stroke treatment:pooled analysis of ATLANTIS,ECASS,and NINDS rt-PA stroke trials[J].Lancet,2004,363(3):768–774.
• [5]胡玉婷,杨楠,魏秀娥,等.缩短院内延迟在缺血性脑卒中静脉溶栓治疗中的临床价值研究[J].卒中与神经疾病,2014,10(5):280-282.
• [6]EMBERSON J,LEES K R,LYDEN P,et al.Effect of treatment delay,age,and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke:a meta-analysis of individual patient data from randomised trials[J].Lancet,2014,10(384):1929-1935.
• [7]黄尚明,吴智鑫.辛辛那提院前脑卒中识别评分量表筛选价值探讨[J].岭南急诊医学杂志,2010,15(6):451-452.
• [8]王拥军.卒中单元[M].北京:科学技术文献出版社,2004:20-24.
• [9]李焰生.解读2013年美国卒中学会《急性缺血性卒中患者早期处理指南》[J].神经病学与神经康复学杂志,2013,10(1):1-4.

文章评论(Comment)：