开展“中国千县万镇卒中识别行动”后区域脑卒中医疗服务流程改进的研究

Study on improvement of medical service capacity of acute ischemic stroke before and after

目的探讨南通市开展“中国千县万镇卒中识别行动”后区域内脑卒中医疗服务流程的改进情况。方法采用多中心、前瞻性、干预性自身前后对照研究,分析“中国千县万镇卒中识别行动”开展前即2020年(1—12月)和开展后即2021年(1—12月)南通市15家医院急性缺血性卒中住院患者发病4.5 h、6 h、24 h、14 d内到院率、静脉溶栓率、机械取栓率,到达医院至静脉使用溶栓药物的时间(DNT)、到达医院至穿刺成功的时间(DPT)的变化。采用χ^(2)检验比较事件率的差异,采用Wilcoxon秩和检验比较DNT和DPT的差异。结果2021年急性缺血性卒中患者发病4.5 h、6 h、24 h内到院率较2020年均显著增高(22.4%vs16.8%,34.9%vs27.0%,56.5%vs47.2%),差异具有统计学意义(χ^(2)=109.588、163.195、186.415,P均<0.001);2021年急性缺血性卒中患者发病4.5 h、发病14 d内静脉溶栓率较2020年均明显增高(53.1%vs46.0%,11.9%vs7.7%),差异具有统计学意义(χ^(2)=20.918、107.849,P均<0.001);2021年急性缺血性卒中患者发病6 h、24 h和14 d机械取栓率较2020年均显著增高(6.8%vs3.5%,4.7%vs2.0%,2.6%vs0.9%),差异具有统计学意义(χ^(2)=34.615、62.053、91.924,P均<0.001);2021年急性缺血性卒中患者静脉溶栓DNT中位数时间较2020年明显缩短(53.8 minvs70.9 min),差异具有统计学意义(Z=0.733,P<0.001);2021年急性缺血性卒中患者机械取栓DPT中位数时间较2020年缩短(119.6 minvs142.5 min),但差异无统计学意义(P>0.05)。结论千县万镇卒中识别行动有效提高了急性缺血性卒中患者到院率、静脉溶栓率和机械取栓率,缩短了DNT,改进了区域卒中医疗服务流程。

Objective To evaluate the improvement of medical service capacity for patients with acute ischemic stroke before and after the implementation of“Stroke recognition in thousands of Counties and towns in China”in Nantong.MethodsThis study was a multi-center,prospective,interventional,self-controlled study,aim to analyze and compare the admission rate,intravenous thrombolysis rate,intravascular therapy rate,door to needle time(DNT),door to puncture time(DPT)of patients with acute ischemic stroke from 15 hospitals in Nantong bwtween 2020(January to December 2020)and 2021(January to December 2021),that is,before and after the implementation of‘Stroke recognition in thousands of counties and towns’.χ^(2)tests were used to compare the difference of event rate and Wilcoxon signed-rank tests were used to compare time variables(DNT and DPT).ResultsIn 2021,the hospital admission rate of patients with acute ischemic stroke within 4.5 h,6 h and 24 h of onset increased significantly compared with that in 2020(22.4%vs16.8%,34.9%vs27.0%,56.5%vs47.2%,χ^(2)=109.588,163.195,186.415;allP<0.001).The rate of intravenous thrombolysis within 4.5 h and 14 d of onset in 2021 was significantly higher than that in 2020(53.1%vs46.0%,11.9%vs7.7%;χ^(2)=20.918,107.849;bothP<0.001).The rate of endovascular therapy within 6 h,24 h and 14 d of onset in 2021 were significantly higher than that in 2020(6.8%vs3.5%,4.7%vs2.0%,2.6%vs0.9%;χ^(2)=34.615,62.053,91.924;allP<0.001).The median DNT of intravenous thrombolysis in 2021 was reduced compared with that in 2020(53.8 minvs70.9 min,Z=0.733,P<0.001).The median DPT of endovascular therapy in 2021 was lower than that in 2020(119.6 minvs142.5 min)with no statistical significance(P>0.05)ConclusionThe“Stroke recognition in thousands of counties and town in China”carried out in Nantong increased the hospital attendance rate,intravenous thrombolysis rate and intravascular treatment rate,shortened intravenous thrombolysis time,and improved the medical service capacity of acute ischemic stroke.