完善卒中绿色通道对提高急性缺血性卒中静脉溶栓率的影响

摘要

Objective To observe the change of door-to-needle time(DNT)and the intravenous thrombolysis rate by recombi-nant tissue plasminogen activator(rt-PA)in the patients with acute ischemic stroke (AIS)after establishing and perfecting the stroke green channel in our hospital.Methods A total of 3 990 patients with AIS in our hospital since 2010 were screened for the statistics on the number of the patients within the time window every year,conducting the analysis on the change trend of the annu-al intravenous thrombolysis rate and DNT.The change situation of DNT and the annual intravenous thrombolysis rate change were compared before the establishment of the stroke green channel and after the establishment and the continuous improvement of the stroke green channel.Results The proportion of AIS patients within the time window in our hospital was significantly lower than that in the domestic developed regions.The intravenous thrombolysis rate by rt-PA achieved the zero breakthrough since the estab-lishment of the stroke green channel in 2011.Along with the continuous improvement of the stroke green channel,the DNT median of the patients within the time window was reduced to 60 min in 2012 and 53.5 min in 2013,moreover the intravenous thrombolysis rate by rt-PA in the patients within the time window was increased from 0 in 2010 to 74.3% in 2013.Conclusion By gradually per-fecting the process of the stroke green channel and strengthening the cooperation of emergency,clinical laboratory and stroke team, DNT is reduced by a large margin and the intravenous thrombolysis rate is substantially increased,which indicates that establishing the perfecting and smooth stroke green channel in the serious pre-hospital delay areas is a necessary measure for increasing the in-travenous thrombolysis rate.%目的：观察该院卒中绿色通道建立并逐步完善后，对缩短急性缺血性卒中（AIS）患者自就诊至接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗时间（DNT）以及静脉溶栓率的影响。方法筛选2010年以来就诊于该院的3990例 AIS患者，对每年时间窗内到院患者人数进行统计，并对静脉溶栓率、DNT的变化趋势进行分析，比较卒中绿色通道建立前后及持续改进后DNT及溶栓率变化情况。结果该院 AIS患者时间窗内到院率明显低于国内发达地区水平，自2011年建立卒中绿色通道后，rt-PA静脉溶栓率实现零的突破，随着绿色通道的持续改进，2012年DNT的中位数缩短至60 min，2013年时间窗内就诊患者的 DNT中位数降至53．5 min，而时间窗内到院患者的rt-PA静脉溶栓率由2010年的0达到2013年的74．3％。结论该院通过逐步完善卒中绿色通道流程，加强急诊科、检验科及卒中小组协作，使患者自入院到接受静脉溶栓治疗时间逐年大幅度缩短，溶栓率大幅度增加。证明在院前延误严重地区，建立院内完善流畅的卒中绿色通道，是增加 AIS患者静脉溶栓率的必要措施。