急性缺血性脑卒中rt-PA静脉溶栓标准化诊疗流程实施效果分析

姚麟连晓鹏秦冰

【摘要】目的探讨急性缺血性脑卒中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓标准化诊疗流程的实施对急性缺血性脑卒中患者诊治过程及疗效的影响。方法将84例急性缺血性脑卒中患者纳入研究，其中rt-PA静脉溶栓标准化诊疗流程实施前8例被设为实施前组，实施后76例被设为实施后组。比较2组的恢复率以及计算实施后组的溶栓率；比较2组患者到达急诊至开始CT/MR扫描、到达急诊至溶栓治疗的时间等。结果实施前组与实施后组的恢复率分别为(14.9±21.4)%、(44.2±38.0)%，实施后组的恢复率明显高于实施前组(t =-2.120，P<0.05)。实施后组76例到达急诊时有溶栓指征的患者有55例最终实施了溶栓，溶栓率达72.4%(55/76)。实施后组患者到达急诊至开始CT/MRI扫描的时间为(38.1±19.5)min，略低于实施前组的(30.5±15.8)min，但比较差异无统计学意义(P>0.05)；实施后组患者到达急诊至溶栓治疗的时间为(191.9±193.4)min，明显低于实施前组的(86.9±29.3)min，两者比较差异有统计学意义(t=3.900， P<0.001)。另外，实施后组患者到达急诊至电话启动流程的时间为(13.1±21.5)min，患者到达急诊至神经内科住院总医师接诊患者的时间为(16.16±22.6)min，患者到达急诊至开始知情同意的时间为(66.8±27.6)min。结论rt-PA静脉溶栓标准化诊疗流程的实施有助于缩短急性缺血性脑卒中患者到达急诊至溶栓治疗的时间、增加其溶栓机会以及提高其治疗效果。

【关键词】急性缺血性脑卒中；重组组织型纤溶酶原激活剂；静脉溶栓；标准化诊疗流程

收稿日期：(2015-07-03)

DOI:10.3969/g.issn.0253-9802.2015.10.015

通讯作者，田明杰，E-mail:2530135881@qq.com

Effect of implementing standard diagnosis and treatment workflow of rt-PA venous thrombolysis in treating acute ischemic strokeYaoLin,LianXiaopeng,QinBing.TheThirdAffiliatedHospitalofSunYat-senUniversity,Guangzhou510630,China

Abstract【】ObjectiveTo investigate the effect of implementation of standard diagnosis and treatment workflow of recombinant tissue-type plasminogen activator (rt-PA) venous thrombolysis upon the diagnosis, treatment and clinical efficacy in patients with acute ischemic stroke. MethodsEighty four acute ischemic stroke patients were enrolled in this study. Eight cases were assigned into the before-implementation group and 76 into the after-implementation group. Recovery rates of two groups were statistically compared. The thrombolysis rate after implementation was calculated. The time interval between arrival at emergent outpatient and starting CT/MR scan and between arrival at emergent outpatient and beginning thrombolysis therapy was statistically compared between two groups. ResultsRecovery rates in before-implementation group and after-implementation group were (14.9±21.4)% and(44.2±38.0)% with statistical significance (t=-2.120，P<0.05). In the after-implementation group, 76 patients presented with thrombolysis indication upon emergent outpatient, eventually 55 (72.4%) of whom undergoing thrombolysis therapy. In the after-implementation group, the time interval between arrival at emergent outpatient and beginning CT/MRI scan was (38.1±19.5) min, slightly shorter compared with (30.5±15.8) min in the before-implementation group without statistical significance (P>0.05). The time interval between arrival at emergent outpatient and beginning thrombolysis therapy was (191.9±193.4) min in the after-implementation group, significantly longer than (86.9±29.3) min in the before-implementation group (t=3.900, P<0.001). In the after-implementation group, the time interval between arrival at emergent outpatient and starting workflow by telephone was (13.1±21.5)min, (16.16±22.6)min between arrival at emergent outpatient and consulting chief resident physician and (66.8±27.6)min between arriving at emergent outpatient and signing the informed consents. ConclusionImplementing standard diagnosis and treatment workflow of rt-PA venous thrombolysis contributes to shorten the time interval between arrival at emergent outpatient and receiving thrombolysis therapy，enhance thrombolysis opportunity and improve the therapy effects.

【Key words】Acute ischemic stroke; Recombinant tissue-type plasminogen activator;

Venous thrombolysis; Standard diagnosis and treatment workflow

急性缺血性脑卒中是急性脑循环障碍迅速导致局限性或弥漫性脑功能缺损的临床事件，是脑部疾病患者死亡和残疾的重要原因之一。我国是脑卒中高发国家，其高发病率、病死率、致残率、复发率给国家和患者家庭带来了巨大的经济负担。静脉溶栓治疗是目前各国急性缺血性脑卒中治疗指南推荐的有效治疗方法[1]。然而，有研究显示，在临床实践中仅少数患者接受了静脉溶栓治疗，且治疗实施受治疗时间窗短等多种因素限制[2]。因此，能否在有限的治疗时间窗内，得到患者(家属)的知情同意，并为患者提供规范标准的静脉溶栓治疗，直接关系到治疗的效果与预后。……