Abstract: Objective To evaluate whether improving emergency medical procedures can impact the door-to- needle time(DNT), the time required when acute ischemic stroke patients have been hospitalised to be treated by intravenous thrombolysis. Methods During January to April in 2015, the experimental group consists of the acute ischemic stroke patients treated by intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA). After starting the green channel, nurses have to immediately mark the patients clearly, write the triage nurse’s screen into the management process and move the rt-PA thrombolytic place from ward to the emergency room simultaneously. The acute ischemic stroke patients treated by intravenous thrombolysis with rt-PA before the process improvement during January to April in 2015 are considered as the control group. Then we evaluate the DNT between the two groups. Results In control group, the median duration of DNT is 133(80-174) min, while the experimental group’s DNT median duration is 102(56-168) min, the two groups have significantly difference( P =0.011). Conclusion Adopt the integrated implementation carried out by multi-disciplinary cooperation and optimize the emergency medical treatment process can reduce the in-hospital delays of rt-PA intravenous thrombolysis.

Key words: Ischemic stroke; Intravenous thrombolysis; Door-needle time; Process

摘要： 目的 探讨改善急诊就医流程对急性缺血性卒中患者入院至静脉溶栓门-针时间 （door-to-needle time， DNT） 的影响。 方法 以2015年1月～4月重组组织型纤溶酶原激活剂 （recombinant tissue plasminogen activator， rt-PA） 静脉溶栓的急性缺血性卒中患者为试验组， 试验组在启动绿色通道后立即给患者及家属佩带明显 标识， 并将分诊护士对患者的筛查纳入绿色通道的管理流程， 同时将rt-PA静脉溶栓地点由病房前移 到急诊室。 以2014年1月～4月改善流程前rt-PA静脉溶栓的急性缺血性卒中患者为对照组， 评价两组 患者DNT时间。 结果 对照组DNT时间中位数133 （80～174） min， 试验组DNT时间102 （56～168） min， 两组有显著差异 （ P =0.011） 。 结论 通过多学科配合实施一系列的综合措施， 优化急性缺血性卒中患者急诊就医流程， 可以减少 rt-PA静脉溶栓的院内延误时间。

关键词: 缺血性卒中; 静脉溶栓; 门-针时间; 流程