拉萨市急性缺血性脑卒中静脉溶栓流程优化效果初探  

Preliminary Study on the Optimization Effect of Intravenous Thrombolysis in Acute Ischemic Stroke in Lhasa

作　　者：周立新 次央[1] 胡亚雄[1] 卓玛 次旦卓嘎[1] 王栋梁[4] 曹旭东[5] 吴科学[5] 赵玉华[1] 彭斌[2,3] ZHOU Lixin;CI Yang;HU Yaxiong;ZHUO Ma;CIDAN Zhuoga;WANG Dongliang;CAO Xudong;WU Kexue;ZHAO Yuhua;PENG Bin(Department of Neurology,Tibet Autonomous Region People􀆳s Hospital,Lhasa 850000,China;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Neurosurgery,Peking University People􀆳s Hospital,Beijing 100044,China;Department of Neurosurgery,Tibet Autonomous Region People􀆳s Hospital,Lhasa 850000,China)

机构地区：[1]西藏自治区人民医院神经内科,拉萨850000 [2]中国医学科学院北京协和医院神经科,北京100730 [3]疑难重症及罕见病国家重点实验室,北京100730 [4]北京大学人民医院神经外科,北京100044 [5]西藏自治区人民医院神经外科,拉萨850000

出　　处：《协和医学杂志》2022年第5期888-894,共7页Medical Journal of Peking Union Medical College Hospital

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费专项基金(2021-RW320-003);西藏自治区科技计划重点研发项目(XZ202001ZY0009G)。

摘　　要：目的探索优化卒中绿色通道救治流程对提高拉萨市急性缺血性脑卒中(acute ischemic stroke,AIS)溶栓质量的效果。方法回顾性纳入2019年8月—2021年12月西藏自治区卒中中心连续上报的采用重组组织型纤溶酶原激活剂静脉溶栓的所有AIS患者。按照患者就诊时卒中绿色通道救治流程是否优化,将其分为优化前组(2019年8月—2021年6月)、优化后组(2021年7—12月)。比较两组静脉溶栓质量及患者预后。结果共纳入34例接受静脉溶栓治疗的AIS患者(平均每月溶栓1.2例),其中优化前组16例、优化后组18例。基线、溶栓后即刻、溶栓后24 h美国国立卫生研究院卒中量表评分分别为6.5(3.0,12.0)分、3.0(1.0,5.5)分、2.0(0,6.3)分。与优化前组比较,优化后组入院至静脉溶栓时间显著缩短[(67.1±37.8)min比(108.9±53.8)min,P=0.035],发病至静脉溶栓时间[(176.7±69.7)min比(199.1±47.8)min,P=0.065]、入院至静脉溶栓时间≤60 min达标率(50.0%比18.8%,P=0.061)、溶栓短期疗效良好患者占比(77.8%比62.5%,P=0.336)数值均有所改善,但差异无统计学意义。结论优化西藏自治区卒中中心绿色通道救治流程后,拉萨市静脉溶栓AIS患者的院内救治时间明显缩短,有助于提高AIS早期治疗的急救效率。Objective To explore the improvement effect of green channel process optimization in acuteischemic stroke(AIS)on intravenous thrombolysis(IVT)quality in Lhasa.Methods All patients with AIS who received IVT by the stroke center of Tibet Autonomous Region from August 2019 to December 2021 were included.According to whether the stroke green channel process was optimized,they were divided into the pre-optimization group(August 2019 to June 2021)and the post-optimization group(July to December 2021).The quality of IVT and stroke prognosis were compared and analyzed between the two groups.Results A total of 34 patients with AIS who received IVT were included(an average of 1.2 patients per month),including 16 in the pre-optimization group and 18 in the post-optimization group.The National Institutes of Health Stroke Scale scores at baseline,immediately after thrombolysis,and 24 hours after thrombolysis were 6.5(3.0,12.0),3.0(1.0,5.5)and 2.0(0,6.3),respectively.The door to needle time in the post-optimization group was significantly shortened,as compared with that of the pre-optimization group[(67.1±37.8)min vs.(108.9±53.8)min,P=0.035].Onset to needle time[(176.7±69.7)min vs.(199.1±47.8)min,P=0.065],the compliance rate of door to needle time≤60 min(50.0%vs.18.8%,P=0.061)and the proportion of good short-term efficacy of thrombolysis(77.8%vs.62.5%,P=0.336)were improved,but the differences were not statistically significant.Conclusions After the process optimization of stroke green channel,the in-hospital delay of IVT for AIS in Lhasa is significantly improved,which is helpful to enhance the first-aid efficiency of early treatment of AIS.

关 键 词：缺血性脑卒中 流程优化 静脉溶栓 西藏自治区卒中中心 

分 类 号：R735.3[医药卫生—肿瘤]