摘要
目的评估通过对急诊绿色通道的优化改进,分析优化前后DNT相关因素变化,对急性缺血性脑卒中患者到院就诊至接受重组组织型纤溶酶原激活剂静脉溶栓治疗时间的改善。方法选取2018-01设立急诊卒中绿色通道以来至2019-04收治的使用阿替普酶(rtPA)静脉溶栓的急性缺血性脑卒中患者62例,以2018-12国家卫生健康委脑卒中防治工程委员会授予我院为“高级卒中中心”为时间分水岭,将急诊绿色通道优化后设为优化组,共30例患者(2018-12—2019-04);优化前设为对照组,共32例患者(2018-01—2018-11),通过对比2组患者从发病到接诊到会诊到达时间、完成采血到检验科接受标本时间(血常规、凝血功能、急诊生化)、检验科接收标本到报告检验结果时间、接诊到CT完成时间、CT完成到交代病情谈话签字时间、签字到静脉用药时间、急诊接诊到静脉溶栓用药时间(DNT),并比较2组患者的DNT时间。结果实施急诊绿色通道的优化改进后,DNT由对照组的87.97 min缩短到优化组64.50 min,差异有统计学意义(P<0.05);对比2组患者接诊到会诊到达时间、接诊到CT完成时间、CT完成到交代病情谈话签字时间、签字到静脉用药时间,优化组均短于对照组,差异有统计学意义(P<0.05);对比2组患者溶栓后24 h NIHSS评分,优化组低于对照组,差异有统计学意义(P<0.05);对比2组患者完成采血到检验科接受标本时间、检验科接收标本到报告检验结果时间,差异无统计学意义(P>0.05),但优化组时间均较对照组缩短。结论通过对急诊绿色通道的优化改进,对影响急性缺血性脑卒中患者静脉溶栓DNT的可控因素进行质量管理,能明显缩短DNT,降低患者溶栓后24 h NIHSS评分,从而改善卒中患者预后。
Objective To evaluate the changes of DNT-Time from seeking a doctor to receiving intravenous thrombolysis with recombinant tissue plasminogen activator in patients with acute ischemic stroke and its related factors influencing DNT after the procedure of emergency care green channel had been optimized.Methods 2018 December,our hospital was awarded Advanced Stroke Center,was regarded as watershed of time.60 acute ischemic stroke patients who had received intravenous thrombolysis treatment between January 2018 and April 2019 were enrolled and randomly divided into two groups30 patients in control group(from January 2018 to November 2018)and 30 patients in optimized group(from December 2018 to April 2019),and to compare DNT and its its related factors influencing DNT including time from onset to received by emergency medicine specialists,time from emergency medicine specialists received by emergency medicine specialists to consultation by neurologists,time from collecting blood to received blood samples by laboratory,time from laboratory received blood samples to reports the results,time from patients received by emergency medicine specialists to CT finished,time from CT finished to patient’s dependents signed informed consent of intravenous thrombolysis treatment.Results After optimization on emergency green channel,mean DNT had been reduced to 64.50 min compared to 87.97 min in control group.The time on related factors influencing DNT was significantly reduced in comparison with control group(P<0.05).Conclusion Optimization on emergency green channel that managing controllable factors affecting DNT dramatically shorten DNT to make this population patients gained a better prognosis.
作者
解晨
谷有全
XIE Chen;GU Youquan(Department of Neurology,the First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《中国实用神经疾病杂志》
2019年第17期1864-1869,共6页
Chinese Journal of Practical Nervous Diseases
