急性缺血性卒中再灌注治疗医疗质量评价与改进专家建议

doi:10.3969/j.issn.1673-5765.2021.07.012

摘要/Abstract

国家神经系统疾病医疗质量控制中心, 中国卒中学会. 急性缺血性卒中再灌注治疗医疗质量评价与改进专家建议[J]. 中国卒中杂志, 2021, 16(07): 705-715.

National Center for Healthcare Quality Management in Neurological Diseases, Chinese Stroke Association. Consensus on Evaluation and Improvement of Healthcare Quality of Acute Ischemic Stroke Reperfusion Therapy[J]. Chinese Journal of Stroke, 2021, 16(07): 705-715.

参考文献

[1] WU S M，WU B，LIU M，et al. Stroke in China：
advances and challenges in epidemiology，prevention，
and management[J]. Lancet Neurol，2019，18（4）：
394-405.
[2] WANG W Z，JIANG B，SUN H X，et al. Prevalence，
incidence，and mortality of stroke in china：results
from a nationwide population-based survey of 480
687 adults[J]. Circulation，2017，135（8）：759-771.
[3] WANG Y J，LI Z X，WANG Y L，et al. Chinese
stroke center alliance：a national effort to improve
healthcare quality for acute stroke and transient
ischaemic attack：rationale，design and preliminary
findings[J]. Stroke Vasc Neurol，2018，3（4）：256-
262.
[4] FIEHLER J，COGNARD C，GALLITELLI M，et
al. European recommendations on organisation of
interventional care in acute stroke（EROICAS）[J].
Eur Stroke J，2016，1（3）：155-170.
[5] DONG Q，DONG Y，LIU L P，et al. The Chinese
Stroke Association scientific statement：intravenous
thrombolysis in acute ischaemic stroke[J]. Stroke
Vasc Neurol，2017，2（3）：147-159.
[6] COLTON K，RICHARDS C T，PRUITT P B，et al.
Early stroke recognition and time-based emergency
care performance metrics for intracerebral
hemorrhage[J/OL]. J Stroke Cerebrovasc Dis，2020，
29（2）：104552[2021-06-11]. https：//doi.org/10.1016/
j.jstrokecerebrovasdis.2019.104552.
[7] POWERS W J，RABINSTEIN A A，ACKERSON
T，et al. Guidelines for the early management of

patients with acute ischemic stroke：2019 update

to the 2018 guidelines for the early management of
acute ischemic stroke[J/OL]. Stroke，2019，50（12）：
e344-e418[2021-06-11]. https：//doi.org/10.1161/
str.0000000000000211.
[8] 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2018. 中国卒中杂志，
2018，13（7）：706-729.
[9] BERGE E，WHITELEY W，AUDEBERT
H，et al. European stroke organisation（ESO）
guidelines on intravenous thrombolysis for
acute ischaemic stroke[J/OL]. Eur Stroke
J，2021，6：I-LXII[2021-06-11]. https：//doi.
org/10.1177/2396987321989865.
[10] ARSAVA E M，FURIE K L，SCHWAMM L H，et al.
Prediction of early stroke risk in transient symptoms
with infarction：relevance to the new tissue-based
definition[J]. Stroke，2011，42（8）：2186-2190.
[11] LI Z X，WANG C J，ZHAO X Q，et al. Substantial
progress yet significant opportunity for improvement
in stroke care in China[J]. Stroke，2016，47（11）：
2843-2849.
[12] 王拥军，李子孝，谷鸿秋，等，中国卒中报告2019（中
文版）（1）[J]. 中国卒中杂志，2020，15（10）：1037-
1043.
[13] 国家卫生健康委办公厅. 国家卫生健康委办公厅关于
印发2021年国家医疗质量安全改进目标的通知[EB/
OL].（2021-02-20）[2021-06-11]. http：//www.nhc.
gov.cn/yzygj/s7657/202102/8c53313663284a7ba1466
48509538ee2.shtml.
[14] 马旭东. 创新医疗质量安全管理模式，目标管理助力
高质量发展[J]. 中国医刊，2021，56（5）：468-469.
[15] FONAROW G C，ZHAO X，SMITH E E，et
al. Door-to-needle times for tissue plasminogen
activator administration and clinical outcomes in
acute ischemic stroke before and after a quality
improvement initiative[J]. JAMA，2014，311（16）：
1632-1640.
[16] SAVER J L，FONAROW G C，SMITH E E，et
al. Time to treatment with intravenous tissue
plasminogen activator and outcome from acute
ischemic stroke[J]. JAMA，2013，309（23）：2480-
2488.
[17] GOYAL M，MENON B K，VAN ZWAM W H，et
al. Endovascular thrombectomy after large-vessel
ischaemic stroke：a meta-analysis of individual
patient data from five randomised trials[J]. Lancet，
2016，387（10029）：1723-1731.
[18] WANG Y J，JING J，MENG X，et al. The third
China national stroke registry（CNSR-Ⅲ）for
patients with acute ischaemic stroke or transient
ischaemic attack：design，rationale and baseline
patient characteristics[J]. Stroke Vasc Neurol，2019，
4（3）：158-164.
[19] LIAO X L，WANG Y L，PAN Y S，et al. Standarddose
intravenous tissue-type plasminogen activator
for stroke is better than low doses[J]. Stroke，2014，
45（8）：2354-2358.
[20] JIA B X，REN Z G，MOKIN M X，et al. Current
status of endovascular treatment for acute large
vessel occlusion in China：a real-world nationwide
registry[J]. Stroke，2021，52（4）：1203-1212.
[21] 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.
[22] RUMALLA K，BURKHARDT J K. Response
by rumalla and burkhardt to letter regarding
article，"recent nationwide impact of mechanical
thrombectomy on decompressive hemicraniectomy
for acute ischemic stroke"[J/OL]. Stroke，2019，50
（11）：e334[2021-06-11]. https：//doi.org/10.1161/
strokeaha.119.027279.
[23] POWERS W J，RABINSTEIN A A，ACKERSON
T，et al. 2018 guidelines for the early management
of patients with acute ischemic stroke：a guideline
for healthcare professionals from the american
heart association/american stroke association[J/
OL]. Stroke，2018，49（3）：e46-e110[2021-06-11].
https：//www.ahajournals.org/doi/10.1161/
STR.0000000000000158.
[24] VAN SWIETEN J C，KOUDSTAAL P J，VISSER M
C，et al. Interobserver agreement for the assessment
of handicap in stroke patients[J]. Stroke，1988，19
（5）：604-607.
[25] HACKE W，KASTE M，BLUHMKI E，et al.
Thrombolysis with alteplase 3 to 4. 5 hours after
acute ischemic stroke[J]. N Engl J Med，2008，359
（13）：1317-1329.
[26] THOMALLA G，SIMONSEN C Z，BOUTITIE
F，et al. MRI-guided thrombolysis for stroke with
unknown time of onset[J]. N Engl J Med，2018，379
（7）：611-622.
[27] MA H，CAMPBELL B C V，PARSONS M W，et
al. Thrombolysis guided by perfusion imaging up to
9 hours after onset of stroke[J]. N Engl J Med，2019，
380（19）：1795-1803.
[28] POWERS W J，DERDEYN C P，BILLER J，et al.
2015 American Heart Association/American Stroke
Association focused update of the 2013 guidelines for
the early management of patients with acute ischemic
stroke regarding endovascular treatment：a guideline
for healthcare professionals from the american heart
association/american stroke association[J]. Stroke，
2015，46（10）：3020-3035.
[29] CASAUBON L K，BOULANGER J M，
BLACQUIERE D，et al. Canadian stroke best
practice recommendations：hyperacute stroke care
guidelines，update 2015[J]. Int J Stroke，2015，10
（6）：924-940.
[30] WANG Y J，ZHAO X Q，LIU L P，et al. Prevalence
and outcomes of symptomatic intracranial large
artery stenoses and occlusions in China：the Chinese
intracranial atherosclerosis (CICAS) study[J]. Stroke，
2014，45（3）：663-669.
[31] SACKS D，BAXTER B，CAMPBELL B C V，et al.
Multisociety consensus quality improvement revised
consensus statement for endovascular therapy of
acute ischemic stroke[J]. J Vasc Interv Radiol，2018，
29（4）：441-453.
[32] KHATRI P，ABRUZZO T，YEATTS S D，et al.
Good clinical outcome after ischemic stroke with
successful revascularization is time-dependent[J].
Neurology，2009，73（13）：1066-1072.
[33] HACKE W，DONNAN G，FIESCHI C，et al.
Association of outcome with early stroke treatment：
pooled analysis of atlantis，ecass，and ninds rt-pa
stroke trials[J]. Lancet，2004，363（9411）：768-774.
[34] LANSBERG M G，SCHROOTEN M，BLUHMKI E，
et al. Treatment time-specific number needed to treat
estimates for tissue plasminogen activator therapy in
acute stroke based on shifts over the entire range of
the modified rankin scale[J]. Stroke，2009，40（6）：
2079-2084.
[35] FRANSEN P S，BERKHEMER O A，LINGSMA H
F，et al. Time to reperfusion and treatment effect for
acute ischemic stroke：a randomized clinical trial[J].
JAMA neurol，2016，73（2）：190-196.
[36] MENON B K，SAJOBI T T，ZHANG Y，et
al. Analysis of workflow and time to treatment
on thrombectomy outcome in the endovascular
treatment for small core and proximal occlusion
ischemic stroke（ESCAPE）randomized，controlled
trial[J]. Circulation，2016，133（23）：2279-2286.
[37] RIBO M，MOLINA C A，COBO E，et al.
Association between time to reperfusion and
outcome is primarily driven by the time from
imaging to reperfusion[J]. Stroke，2016，47（7）：
999-1004.
[38] SAVER J L，GOYAL M，VAN DER LUGT A，et al.
Time to treatment with endovascular thrombectomy
and outcomes from ischemic stroke：a metaanalysis[
J]. JAMA，2016，316（12）：1279-1288.
[39] SAVER J L，GOYAL M，BONAFE A，et al. Stentretriever
thrombectomy after intravenous t-PA vs
t-PA alone in stroke[J]. N Engl J Med，2015，372
（24）：2285-2295.
[40] GOYAL M，DEMCHUK A M，MENON B K，et
al. Randomized assessment of rapid endovascular
treatment of ischemic stroke[J]. N Engl J Med，2015，
372（11）：1019-1030.
[41] LESLIE-MAZWI T，CHEN M，YI J L，et al. Postthrombectomy
management of the elvo patient：
guidelines from the Society of Neurointerventional
Surgery[J]. J Neurointerv Surg，2017，9（12）：1258-
1266.
[42] 中国卒中学会重症脑血管病分会专家撰写组. 急性
缺血性脑卒中血管内治疗术后监护与管理中国专家
共识[J]. 中华医学杂志，2017，97（3）：162-172.
[43] BERKHEMER O A，FRANSEN P S，BEUMER D，
et al. A randomized trial of intraarterial treatment
for acute ischemic stroke[J]. N Engl J Med，2015，372
（1）：11-20.
[44] CAMPBELL B C，MITCHELL P J，KLEINIG T J，
et al. Endovascular therapy for ischemic stroke with
perfusion-imaging selection[J]. N Engl J Med，2015，
372（11）：1009-1018.
[45] MOCCO J，ZAIDAT O，VON KUMMER R，et al.
Aspiration thrombectomy after intravenous alteplase
versus intravenous alteplase alone[J]. Stroke，2016，
47（9）：2331-2338.
[46] BRACARD S，DUCROCQ X，MAS J，et al.
Mechanical thrombectomy after intravenous
alteplase versus alteplase alone after stroke
（THRACE）：a randomised controlled trial[J].
Lancet Neurol，2016，15（11）：1138-1147.
[47] MUIR K，FORD G，MESSOW C，et al.
Endovascular therapy for acute ischaemic stroke：the
pragmatic ischaemic stroke thrombectomy evaluation
（PISTE）randomised，controlled trial[J]. J Neurol
Neurosurg Psychiatry，2017，88（1）：38-44.
[48] KRUMHOLZ H M，KEENAN P S，BRUSH J
E，et al. Standards for measures used for public
reporting of efficiency in health care：a scientific
statement from the American Heart Association
interdisciplinary council on quality of care and
outcomes research and the American College of
Cardiology Foundation[J]. Circulation，2008，118
（18）：1885-1893.
[49] JAHAN R，SAVER J L，SCHWAMM L H，et
al. Association between time to treatment with
endovascular reperfusion therapy and outcomes in
patients with acute ischemic stroke treated in clinical
practice[J]. JAMA，2019，322（3）：252-263.
[50] FORD A L，WILLIAMS J A，SPENCER M，et
al. Reducing door-to-needle times using toyota's
lean manufacturing principles and value stream
analysis[J]. Stroke，2012，43（12）：3395-3398.
[51] WANG Y J，LI Z X，ZHAO X Q，et al. Effect of
a multifaceted quality improvement intervention
on hospital personnel adherence to performance
measures in patients with acute ischemic stroke in
China：a randomized clinical trial[J]. JAMA，2018，
320（3）：245-254.
[52] FONAROW G C，SMITH E E，SAVER J L，et al.
Improving door-to-needle times in acute ischemic
stroke：the design and rationale for the American
Heart Association/American Stroke Association's
Target：Stroke initiative[J]. Stroke，2011，42（10）：
2983-2989.
[53] American heart Heart association Association.
phase-III target：stroke[EB/OL]. （2018-07-13）
[2021-06-26]. https：//www.heart.org/-/media/files/
professional/quality-improvement/target-stroke/
target-stroke-phase-iii/ts-phase-iii-5-6-19/final5619-
target-stroke-phase-3-brochure.pdf?.la=en.
[54] FONAROW G C，REEVES M J，SMITH E E，et
al. Characteristics，performance measures，and inhospital
outcomes of the first one million stroke
and transient ischemic attack admissions in get
with the guidelines-stroke[J]. Circ Cardiovasc Qual
Outcomes，2010，3（3）：291-302.
[55] 国家卫生和计划生育委员会神经内科医疗质量控
制中心. 中国卒中中心建设指南[J]. 中国卒中杂志，
2015，10（6）：432-440.
[56] PRASAD K，TIWARI S. Therapeutic interventions
for advanced glycation-end products and its receptormediated
cardiovascular disease[J]. Curr Pharm Des，
2017，23（6）：937-943.
[57] SUN C H，BHATT D L，NOGUEIRA R G，et
al. Endovascular therapy for stroke：getting to the
"heart" of the matter[J]. Circulation，2014，129（10）：
1152-1160.
[58] MCTAGGART R A，ANSARI S A，GOYAL M，et
al. Initial hospital management of patients with
emergent large vessel occlusion（ELVO）：report
of the standards and guidelines committee of
the Society of Neurointerventional Surgery[J]. J
Neurointerv Surg，2017，9（3）：316-323.
[59] MCTAGGART RA，YAGHI S，BAIRD G，et al.
Decreasing procedure times with a standardized
approach to elvo cases[J]. J Neurointerv Surg，2017，
9（1）：2-5.
[60] SETTECASE F，MCCOY D B，DARFLINGER
R，et al. Improving mechanical thrombectomy
time metrics in the angiography suite：stroke cart，
parallel workflows，and conscious sedation[J]. Interv
Neuroradiol，2018，24（2）：168-177.
[61] FREI D，MCGRAW C，MCCARTHY K，et al. A
standardized neurointerventional thrombectomy
protocol leads to faster recanalization times[J]. J
Neurointerv Surg，2017，9（11）：1035-1040.
[62] SCHONENBERGER S，UHLMANN L，HACKE
W，et al. Effect of conscious sedation vs general
anesthesia on early neurological improvement
among patients with ischemic stroke undergoing
endovascular thrombectomy：a randomized clinical
trial[J]. JAMA，2016，316(19)，1986-1996.
[63] 李子孝，刘翔宇，朱皞罡，等. 基于区块链技术的缺
血性卒中医疗质量评价应用初探[J]. 中国卒中杂志，
2020，15（6）：578-586.
[64] 王春娟，王伊龙，李子孝，等. 基于绿色通道的溶栓
医疗质量持续改进模式[J]. 中国卒中杂志，2016，11
（11）：1003-1005.