流程改进与智能时间追踪在急性缺血性脑卒中溶栓流程中的作用

Effect of Optimization of Emergency Procedures and Time Tracking on Thrombolysis Process for Patients with Acute Ischemic Stroke

目的研究急性缺血性脑卒中流程改进与电子信息智能时间追踪系统对缩短缺血性脑卒中患者从入院到溶栓治疗的时间(door to needle time,DNT)及溶栓率的影响。方法选取我院神经内科收治的2592例急性缺血性脑卒中(acute ischemic stroke,AIS)患者,其中静脉溶栓患者共243例,优化流程前组有106例,优化流程后组有137例。回顾分析开通绿色通道及智能时间追踪前、后两组接受静脉溶栓的AIS患者的临床资料。对两组患者的DNT、DNT≤60分钟的比例,以及时间窗内患者溶栓率及总溶栓率进行分析,比较优化流程并采取智能时间追踪前后上述指标的变化。结果优化流程并利用电子信息系统实时监控后,年龄>80岁的患者比例增高(P<0.05),DNT显著缩短(P<0.01),且时间窗内就诊的AIS患者溶栓率有了明显的提高(P<0.01),而总体AIS患者溶栓率虽有提高,但差异无统计学意义(P>0.05)。两组患者在症状性出血转化及死亡方面差异无统计学意义(P>0.05)。结论启动急性缺血性脑卒中静脉溶栓绿色通道及智能时间追踪系统可显著缩短DNT,提高时间窗内患者溶栓率及总溶栓率,且安全有效。

Objective To study the effect of emergency procedures optimization and the implementing of intelligent time tracking systemon the reduction of door to needle time（ DNT） and the thrombolysis rate in patients with acute ischemic stroke.Methods 2592 acute ischemic stroke（ AIS） patients who were treated at neurology department from September 2014 to September 2016 were taken as example,including 243 patients who were treated with intravenous thrombolytic therapy. The 243 patients were divided into two groups： 106 cases before the process of emergency procedures optimization and 137 cases after the process of emergency procedures optimization. The clinical data of the two groups was retrospectively analyzed before and after emergency procedures optimization and the implementing of intelligent time tracking system since December 2015. And then analyzed and compared the differences in indicators of DNT,the rate of DNT≤60 minutes. The thrombolysis rate of AIS patients and the overall thrombolysis rate within time window were analyzed. And the change of the above indexes was compared before and after emergency procedures optimization and the implementing of intelligent time tracking system. Results After the implementing of emergency procedures optimization and intelligent time tracking system,the DNT was significantly shortened（ P 0. 01） with the percentage of age 80 or more patients increased（ P 0. 05）. The thrombolysis rate of AIS patients within the time window increased remarkably（ P 0. 01）,while the overall thrombolysis rate of all AIS patients was increased,but no statistical difference（ P 0. 05）. The differences on symptomatic hemorrhagic transformation and death rate between the two groups had no statistically significant difference（ P 0. 05）. Conclusions There is high potential clinical value to initiate the green channel of intravenous thrombolysis and the intelligent time tracking system for acute ischemic stroke patients for its effects on significantly shortening the DNT,increasing the thrombolysis rate of AIS patients and the overall thrombolysis rate within time window on the basis of safety and high efficiency.