时间追踪对缺血性卒中患者静脉溶栓流程速度的影响

Effect of time tracking on speed of tissue-type plasminogen activator treatment in patients with acute ischemic stroke

目的 探讨时间追踪对静脉溶栓流程速度的影响,并明确入院至溶栓时间（door to needle time,DNT）与发病至入院时间（onset to door time,ODT）的相关性.方法 前瞻性收集2012年10月启动时间追踪后静脉溶栓患者的时间追踪表,并回顾性分析启动时间追踪前、后2009年6月至2013年9月间接受静脉溶栓的缺血性卒中患者的临床资料.比较启动时间追踪前、后入选病例的基线特点,并对ODT与DNT进行相关性分析.结果 共纳入342例静脉溶栓的缺血性卒中患者.启动时间追踪前的静脉溶栓患者中,ODT与DNT呈明显负相关（r=-0.169,P=0.015）,且短暂性脑缺血发作/卒中病史（β =-0.168,P=0.020）及ODT（β=-0.246,P=0.001）是影响DNT的独立危险因素.与启动时间追踪前相比,启动时间追踪后的静脉溶栓患者中,高龄者比例增高[19.4％（25/129）与10.3％（22/213）;x2=5.552,P=0.018],基线神经功能缺损程度较轻[（11.0 ±6.3）分与（12.5±6.7）分;=2.065,P=0.040],采用多模式影像学检查者比例增多[63.6％（82/129）与51.6％（110/213）;x2=4.638,P=0.031],DNT显著缩短[（87.6±33.2） min与（108.4 ±52.4） min;t=4.274,P =0.000],且以发病1h内就诊者DNT缩短最为显著[（90.3±21.0） min与（132.5±46.0） min;t=5.048,P=0.000],DNT与ODT两者间无明显相关性（r=-0.013,P=0.885）.结论 启动时间追踪可缩短DNT,并可有效消除ODT对DNT的影响.

Objective To explore the effect of time tracking on speed of tissue-type plasminogen activator treatment in patients with acute ischemic stroke,and the correlation between door to needle time （DNT） and onset to door time （ODT）.Methods Time tracking tables had been prospectively collected since October 2012.The data of intravenous thrombolytic candidates with acute ischemic stroke were retrospectively reviewed from June 2009 to September 2013.Baseline characteristics and the correlation between ODT and DNT were assessed respectively before and after the implementation of time tracking.Results Three hundred and forty-two cases were finally included.Before the implementation of time tracking,ODT was negatively correlated with DNT （r =-0.169,P =0.015） ; Patients with transient ischemic attack （TIA）/stoke history （β =-0.168,P =0.020） and ODT （β =-0.246,P =0.001）accounted for the length of DNT independently.Since the implementation of time tracking,the elderly accounted for more （19.4% （25/129） vs 10.3% （22/213） ; x2 =5.552,P =0.018）,the baseline nervous impairment was NIHSS scores （milder 11.0 ± 6.3 vs 12.5 ± 6.7 ; t =2.065,P =0.040）,the proportions of patients taking multi-modality imaging were larger （63.6% （82/129） vs 51.6% （110/213） ; x2 =4.638,P =0.031） and the DNT decreased significantly （（87.6 ± 33.2） min vs （108.4 ± 52.4） min;t =4.274,P =0.000）,which was especially seen in patients arrived within 1 hour after onset （（90.3 ±21.0） min vs （132.5 ± 46.0） min; t =5.048,P =0.000）,and the previous inversely correlated DNT and ODT （r=-0.169,P=0.015） became irrelevant （r=-0.013,P=0.885）.Conclusion Implementation of time tracking reduces DNT,and clears up the effect of ODT on DNT.