河北医科大学学报 ›› 2020, Vol. 41 ›› Issue (11): 1256-1260.doi: 10.3969/j.issn.1007-3205.2020.11.004

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卒中溶栓绿色通道优化研究及实施效果分析

  

  1. 河北省石家庄市人民医院神经内科三病区，河北 石家庄 050011
  • 出版日期:2020-11-25 发布日期:2020-11-30
  • 作者简介:李婧（1982-），女，河北南宫人，河北省石家庄市人民医院主治医师，医学硕士，从事神经内科疾病诊治研究。
  • 基金资助:
    河北省医学科学研究重点课题计划（20181012）

Study on the optimization of green channel for thrombolysis in stroke and analysis of its application effects#br#
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  1. Department of 3rd Neurology, the People′s Hospital of Shijiazhuang， Hebei Province, Shijiazhuang 050011, China
  • Online:2020-11-25 Published:2020-11-30

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摘要： 目的  探讨卒中溶栓绿色通道的构建、整改对发病到实施溶栓的时间（onset to treatment time,OTT）、院内溶栓时间（door to needle time，DNT）、临床疗效及预后的影响。
方法  收集通过绿色通道溶栓患者118例的临床资料，以时间为界分为对照组57例和观察组61例。比较2组OTT、DNT、DNT≤60 min比率、临床疗效、并发症发生情况、美国国立卫生研究院卒中量表（the National Institutes of Health Stroke Scale,NIHSS）评分、Barthel指数（Barthel index，BI）评分、改良Rankin量表（Modified Rankin Scale,mRS）评分等。
结果  观察组OTT、DNT短于对照组，DNT≤60 min比例高于对照组（P＜0.01）。经过溶栓治疗72 h后，观察组临床疗效优于对照组，总有效率高于对照组（P＜0.01）。2组总并发症发生率和病死率差异均无统计学意义（P＞0.05）。2组NIHSS评分均呈逐渐降低趋势，观察组NIHSS评分低于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.01）。2组BI评分均呈逐渐升高趋势，观察组BI评分高于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.01）。治疗3个月以后，观察组mRS评分明显低于对照组，≤2分比例高于对照组（P＜0.01）。
结论  卒中溶栓绿色通道的建立，能够显著缩短OTT、DNT，提高临床疗效，减轻残障程度，取得良好的社会效益。


关键词: 卒中, 溶栓绿色通道, 质控整改, 治疗结果

Abstract: Objective  To explore the influence of the construction and rectification of the green channel for thrombolysis in stroke on the time from onset to treatment time（OTT）, the door to needle time（DNT）, thrombolysis rate, clinical efficacy and prognosis of thrombolysis, and highlight the value of the construction and rectification of the green channel for stroke. 
Methods  The clinical data of 118 patients with thrombolytic therapy through green channel were collected and divided into control group(57 cases) and observation group(61 cases) according to time. The OTT, DNT, DNT≤60 min ratio, National Institute of Health stroke scale（NIHSS） score, significant efficiency, complications and Modified Rankin Scale（mRS） score were compared between two groups. 
Results  The OTT and DNT of observation group were shorter than those of control group, and the proportion of DNT≤60 min was higher than that of control group(P＜0.01). After 72 hours of thrombolytic therapy, the clinical efficacy of observation group was better than that of control group, and the total effective rate was higher than that of control group(P＜0.01). There was no significant difference in the incidence of complications and mortality between the two groups(P＞0.05). The NIHSS scores of the two groups were gradually decreased, and the NIHSS score of the observation group was lower than that of control group and the differences of interaction among groups, time points and time points between groups were statistically significant(P＜0.01). The BI scores of two groups were gradually increased, and the BI score of the observation group was higher than that of the control group. The differences of interaction between groups, time points and time points between groups were statistically significant(P＜0.01).After 3 months of treatment, the mRS score of observation group was significantly lower than that of control group, and the proportion of ≤ 2 points was higher than that of control group(P＜0.01). 
Conclusion  Through the establishment of the green channel for thrombolysis， the OTT and DNT can be significantly shortened, the thrombolysis rate and the efficacy of cerebral infarction can be improved, and the degree of disability can be reduced, thus achieving good social benefits.


Key words: stroke, thrombolytic green channel, quality improvement, treatment outcome

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