优化溶栓流程对轻型急性缺血性卒中院内延误及预后的影响

doi:10.3969/j.issn.1673-5765.2019.12.002

摘要/Abstract

摘要：

目的分析优化溶栓流程对轻型急性缺血性卒中患者院内延误及预后的影响。方法回顾性收集秦皇岛市第一医院2015年7月-2017年6月行静脉溶栓治疗的轻型缺血性卒中患者资料。按照流程优化时间前后，分为优化组和对照组。比较两组入院到溶栓时间（door to needle time， DNT）、溶栓后7 d NIHSS评分和溶栓后3个月mRS评分。结果共纳入57例轻型缺血性卒中患者，平均年龄61.7±5.4岁，男性44例（77.2%）。其中对照组 24例，优化组33例。两组患者一般资料比较差异无统计学意义。与对照组比较，优化组DNT缩短（68.7±19.1 vs 88.8±23.1 mi n，P =0.001），DNT≤60 min的患者比例更高（42.4% vs 12.5%，P =0.015）；溶栓治疗后3个月mRS评分更低[0（0～0.5）vs 0.5（0～2），P =0.017]，良好预后（mRS评分≤1分）患者比例更高（87.9% vs 62.5%，P =0.024）。结论优化溶栓流程可以缩短轻型急性缺血性卒中患者的DNT，提高DNT≤60 mi n达标率，改善患者 3个月预后。

文章导读： 优化溶栓流程可缩短轻型急性缺血性卒中患者的DNT，提高DNT≤60 mi n达标率，并改善患者预后。

关键词: 轻型卒中; 溶栓流程; 院内延误; 预后

Abstract:

Objective To investigate the effect of optimized thrombolysis treatment workflow on door to needle time (DNT) and prognosis in acute mild ischemic stroke patients with intravenous thrombolysis. Methods Data of mild ischemic stroke patients receiving intravenous thrombolysis from July 2015 to June 2017 in the First Qinhuangdao Hospital were retrospectively collected. According to whether thrombolysis treatment workflow was optimized or not, all patients were divided into the optimization group and the control group. Door to needle time (DNT), NIHSS score at 7 days and mRS score at 3 months after thrombolysis of two groups were compared. Results A total of 57 mild ischemic stroke patients were included, with a mean age of 61.7±5.4 years old and 44 males (77.2%). There were 33 patients in optimization group and 24 patients in control group. The general information had no statistical difference between the two groups. DNT was shorter (68.7±19.1 vs 88.8±23.1 min, P =0.001), the percentage of patients with DNT ≤60 min was higher (42.4% vs 12.5%, P =0.015), the mRS score at 3 months was lower [0 (0-0.5) vs 0.5 (0- 2), P =0.017], and the rate of patients with mRS score ≤1 at 3 months was higher (87.9% vs 62.5%, P =0.024) in optimization group, compared with that in control group. Conclusions The optimized thrombolysis treatment workflow can shorten DNT, improve the rate of DNT ≤60 min, and improve 90-day prognosis in patients with acute mild ischemic stroke.

Key words: Mild stroke; Thrombolysis treatment workflow; In-hospital delay; Prognosis

王耀辉, 张重阳, 孙伟, 吕喆, 刘维斌. 优化溶栓流程对轻型急性缺血性卒中院内延误及预后的影响[J]. 中国卒中杂志, 2019, 14(12): 1205-1208.

WANG Yao-Hui, ZHANG Chong-Yang, SUN Wei, LYU Zhe, LIU Wei-Bin. Effect of Optimized Thrombolysis Treatment Workflow on In-hospital Delay and Prognosis in Acute Mild Ischemic Stroke[J]. Chinese Journal of Stroke, 2019, 14(12): 1205-1208.

参考文献

[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

2018[J]. 中华神经科杂志，2018，51（9）：666-682.

[2] 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.

[3] HACKE W，KASTE M，FIESCHI C，et al.

Randomised double-blind placebo-controlled trial of

thrombolytic therapy with intravenous alteplase in

acute ischaemic stroke（ECASS Ⅱ）[J]. The Lancet，

1998，352（9136）：1245-1251.

[4] FRANK B，GROTTA J C，ALEXANDROV A V，et

al. Thrombolysis in stroke despite contraindications

or warnings?[J]. Stroke，2013，44（3）：727-733.

[5] KHATRI P，CONAWAY M R，JOHNSTON K C，et

al. Ninety-day outcome rates of a prospective cohort

of consecutive patients with mild ischemic stroke[J].

Stroke，2012，43（2）：560-562.

[6] LEIRA E C，LUDWIG B R，GUROL M E，et al.

The types of neurological deficits might not justify

withholding treatment in patients with low total

National Institutes of Health Stroke Scale scores[J].

Stroke，2012，43（3）：782-786.

[7] KHATRI P，TAYAMA D，COHEN G，et al. Effect

of intravenous recombinant tissue-type plasminogen

activator in patients with mild stroke in the Third

International Stroke Trial-3：post hoc analysis[J].

Stroke，2015，46（8）：2325-2327.

[8] 中国卒中学会科学声明专家组. 急性缺血性卒中静

脉溶栓中国卒中学会科学声明[J]. 中国卒中杂志，

2017，12（3）：267-284.

[9] MERETOJA A，KESHTKARAN M，SAVER J

L，et al. Stroke thrombolysis：save a minute，save a

day[J]. Stroke，2014，45（4）：1053-1058.

[10] 王耀辉，张重阳，孙伟，等. 基于急救医疗服务的院

前干预对急性缺血性脑卒中静脉溶栓门-针时间的影

响[J]. 中华危重病急救医学，2018，30（7）：667-670.

[11] National Institute of Neurological Disorders

and Stroke rt-PA Stroke Study Group. Tissue

plasminogen activator for acute ischemic stroke[J].

N Engl J Med，1995，333（24）：1581-1587.

[12] SHI L，ZHANG M，LIU H，et al. Safety and

outcome of thrombolysis in mild stroke：a metaanalysis[

J/OL]. Med Sci Monit，2014，20：2117-2124.

http：//doi.org/10.12659/MSM.892259.

[13] LOGALLO N，KVISTAD C E，NAESS H，et al.

Mild stroke：safety and outcome in patients receiving

thrombolysis[J]. Acta Neurol Scand Suppl，2014，129

（s198）：37-40.

[14] 于若梅，曹谡涵，毛保义，等. 重组组织型纤溶酶原

激活剂静脉治疗轻型缺血性卒中患者的疗效分

析[J]. 中国卒中杂志，2018，13（9）：903-907.

[15] 张重阳，王耀辉，刘宇鹏，等. 溶栓模式对急性缺血

性脑卒中静脉溶栓DNT的影响及效果分析[J]. 中华

急诊医学杂志，2019，28（6）：755-759.