专职卒中救治团队对急性脑梗死静脉溶栓及介入取栓质量的影响  

Effect of full-time stroke treatment team on the quality of intravenous thrombolysis and interventional thrombectomy for acute cerebral infarction

作　　者：刘丽霞 于香利 张朋 李道静 齐子有 郝永楠[2] 张爱梅[1] Liu Lixia;Yu Xiangli;Zhang Peng;Li Daojing;Qi Ziyou;Hao Yongnan;Zhang Aimei(Department of Neurology,Affiliated Hospital of Jining Medical University,Jining,Shandong 272100,China)

机构地区：[1]济宁医学院附属医院神经内科,272100 [2]济宁医学院附属医院急诊卒中科,272100 [3]济宁医学院研究生院

出　　处：《中国脑血管病杂志》2023年第10期667-675,共9页Chinese Journal of Cerebrovascular Diseases

基　　金：济宁市重点研发计划项目(2022YXNS082)。

摘　　要：目的探讨专职卒中救治团队对急性脑梗死静脉溶栓及介入取栓治疗质量的影响。方法回顾性连续纳入济宁医学院附属医院经卒中绿色通道给予静脉溶栓和介入取栓治疗的急性脑梗死患者为研究对象,其中对照组纳入2018年6月1日至2020月5月31日即专职卒中救治团队成立前的2年内收治的急性脑梗死静脉溶栓患者355例及介入取栓患者85例;2020年6月1日开始成立专职卒中救治团队,由脑血管病专业方向的神经内科医师、神经外科医师、急诊护士及神经内外科护士组成,有全职科主任和护士长,独立的病房,专门收治需静脉溶栓和(或)介入取栓治疗的超急性期脑梗死患者,以自成立专职卒中救治团队至2022年5月31日2年内收治的急性脑梗死静脉溶栓患者757例及介入取栓患者277例为观察组。比较两组患者静脉溶栓率、就诊至开始静脉溶栓治疗的时间(DNT)、就诊至介入取栓股动脉穿刺时间(DPT)、DNT≤60 min达标率、DPT≤90 min达标率、静脉溶栓并发症发生率、介入取栓并发症发生率、介入取栓患者住院病死率、介入取栓血管再通率等。结果观察组及对照组静脉溶栓及介入取栓患者年龄、性别、高血压病、糖尿病、冠心病、吸烟、饮酒等基线资料差异均无统计学意义(均P>0.05);对照组急性脑梗死静脉溶栓患者355例,同期首诊的发病14 d内住院脑梗死患者为5877例,静脉溶栓率为6.0%;观察组急性脑梗死静脉溶栓患者为757例,同期首诊的发病14 d内住院脑梗死患者为7306例,静脉溶栓率为10.4%;观察组静脉溶栓率明显高于对照组(χ^(2)=8.826,P<0.01)。观察组静脉溶栓DNT为(44±23)min,较对照组DNT[(55±25)min]明显缩短,组间差异有统计学意义(t=3.386,P<0.01);对照组DNT≤60 min达标率为51.5%(183/355),观察组DNT≤60 min达标率为69.4%(525/757),组间差异有统计学意义(χ^(2)=9.954,P<0.01)。对照组静脉溶栓发生并发症共15例Objective To explore the effect of establishing a full-time stroke treatment team on the quality of intravenous thrombolysis and interventional thrombectomy for acute cerebral infarction.Methods Patients with acute cerebral infarction who received intravenous thrombolysis and interventional thrombectomy through stroke green channel in Department of Neurology,Affiliated Hospital of Jining Medical University were retrospectively and consecutively selected as the research objects.Among them,355 patients with acute cerebral infarction treated with intravenous thrombolysis and 85 patients with interventional thrombectomy within 2 years before the establishment of the full-time stroke treatment team from June 1,2018 to May 31,2020 were selected as the control group.On June 1,2020,the full-time stroke treatment team was established composed of neurologist,neurosurgeons,emergency nurses and neurological nurses major on the cerebrovascular disease.Professional direction of a full-time department director,head nurse,and independent ward,specialized for treatment and intravenous thrombolysis and(or)the thrombolysis treatment of hyperacute cerebral infarction patients.Since the establishment of full-time stroke treatment team to May 31,2022,757 acute cerebral infarction cases for intravenous thrombolysis and 277 cases for interventional thrombectomy were enrolled as the observation group.Referring to the requirements of China Cerebrovascular Disease Big Data Platform for stroke center related quality control indicators,the study compared the rate of intravenous thrombolysis,door to needle time(DNT),door to puncture time(DPT),compliance rate of DNT≤60 minutes,compliance rate of DPT≤90 minutes,complication rate of intravenous thrombolysis,complication rate of interventional thrombectomy,in-hospital mortality of patients with interventional thrombectomy,and recanalization rate of interventional thrombectomy.Results There were no significant differences in age,gender,hypertension,diabetes,coronary heart disease,smoking,drink

关 键 词：脑梗死 卒中救治团队 卒中绿色通道 

分 类 号：R743.3[医药卫生—神经病学与精神病学]