多学科团队协作模式在MRI指导下脑卒中静脉溶栓诊疗中的应用  

The Application of Multidisciplinary Team Assistance Model in the Diagnosis and Treatment of Acute Ischemic Stroke

作　　者：魏丽 邢婷婷 陆练军[1] 沈健[1] 赵振国[2] 白青科[1] WEI Li;XING Ting-ting;LU Lian-jun;SHEN Jian;ZHAO Zhen-guo;BAI Qing-ke(Department of Neurology,Shanghai Pudong New Area People's Hospital,Shanghai 201200,China;Department of Radiology,Shanghai Pudong New Area People's Hospital,Shanghai 201200,China)

机构地区：[1]上海市浦东新区人民医院神经内科,上海201200 [2]上海市浦东新区人民医院影像科,上海201200

出　　处：《中国临床神经科学》2019年第6期652-657,共6页Chinese Journal of Clinical Neurosciences

基　　金：上海市浦东新区卫计委重点学科群资助(编号:PWZxq2017-02)

摘　　要：目的探讨多学科团队协助模式在脑卒中静脉溶栓诊疗中的应用,为急性脑梗死的诊疗提供参考。方法选取2017年1~12月行rt-PA静脉溶栓治疗的113例急性缺血性脑卒中患者为对照组,另选取流程改进后(2018年1~12月)行rt-PA静脉溶栓治疗的120例急性缺血性脑卒中患者为观察组,分析就诊至完善影像学检査时间、就诊至溶栓开始时间(DNT)时间、静脉溶栓治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分、Barthel指数变化、有无出血并发症等影响因素。结果观察组CT至完成头颅MRI时间、MR至静脉溶栓时间、DNT时间均较对照组缩短(PvO.05);两组溶栓后24 h NIHSS评分改善差异无统计学意义(P>0.05),观察组溶栓后7、30和90 d NIHSS评分、mRS评分.Barthel指数改善均优于对照组(Pv0.05);静脉溶栓过程中牙龈出血及症状性颅内出血两组比较差异无统计学意义(P>0.05)o结论多学科团队协助模式可有效缩短急性缺血性脑卒中患者的就诊时间、检查时间及DNT时间,促进患者的神经功能恢复。Aim To explore the application of multidisciplinary team assistance model in the diagnosis and treatment of acute ischemic stroke.Methods From January 2017 to December 2017,there were 113 patients with acute ischemic stroke(AIS)treated by intravenous thrombolysis(IVT)in our hospital,and they were selected as the control group.Since January 2018,the process has been improved and there were 120 cases with AIS treated by IVT.The latter was selected as the observation group.The main evaluation indicators were compared,including the time from consultation to perfect imaging examination,time from door to needle,changes of the National Institute of Health Stroke Scale score,changes of the Modified Rankin Scale(mRS),changes of the Barthel index,and the incidence of complications.Results The time from computed tomography(CT)to magnetic resonance imaging(MRI),the time from MR to the treatment,and the time of door-to・needle(DNT)in the observation group were shorter than those in the control group(P<0.05).There was no significant difference in the improvement of NIHSS 24 hours after IVT between the two groups.The NIHSS,mRS and Barthel index of the observation group were better than those of the control group at 7,30 and 90 days,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in gingival bleeding during IVT and ICH after IVT(P>0.05).Conclusion Multidisciplinary team assistance model can effectively shorten the time of consultation,examination and DNT,thus promote the recovery of neurological function in patients with acute ischemic stroke.

关 键 词：多学科团队协助模式 磁共振成像 急性缺血性脑卒中 静脉溶栓 

分 类 号：R743[医药卫生—神经病学与精神病学]