时间追踪在缺血性卒中患者溶栓流程中的作用

Effect of Time Tracking on Thrombolysis Process for Patients with Ischemic Stroke

目的研究时间追踪对缺血性卒中患者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2013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2010年6月—2014年9月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、后入选病例的基线资料,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,其中启动静脉溶栓时间追踪前共纳入213例(追踪前组),启动后共纳入129例(追踪后组)。与追踪前组相比,追踪后组年龄>80岁的患者比例增高(P<0.05)、基线神经功能缺损程度较轻(P<0.05)、采用多模式影像学检查者比例增高(P<0.05)、DNT显著缩短(P<0.01),且以发病60 min内就诊者DNT缩短最为显著(P<0.01)。追踪前组ODT与DNT呈显著负相关(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。DNT与ODT两者间无明显相关性(r=-0.013,P=0.885)。结论启动静脉溶栓时间追踪模式可缩短DNT,并可有效消除ODT对DNT的影响,提高缺血性卒中患者的静脉溶栓疗效,改善预后。

Objective To study the effect of time tracking on intravenous thrombolysis for patients with ischemic stroke, and to confirm the correlation between door to needle time （DNT） and onset to door time （ODT）. Methods Time tracking tables of patients with intravenous thrombolysis after time tracking was started in October 2013 were prospectively collected, and the clinical data of ischemic stroke patients with intravenous thrombolysis was retrospectively analyzed before and after the time tracking during June 2010 and September 2014. The baseline data of the selected patients before and after the time tracking was compared, and the correlation between DNT and ODT was also analyzed. Results A total of 342 ischemic stroke patients with intravenous thrombolysis were recruited in this study, of whom 213 patients （before tracking group, BT group） before the time tracking were included, and 129 patients （after tracking group, AT group） after the time tracking were included. Compared with those in BT group, in AT group, the number of patients over 80 years old was bigger （P 〈 0.05 ）, baseline neurologie impairment degrees of patients were lighter （ P 〈 0.05 ）, the radio of using multi modes of imaging examination was bigger （ P 〈 0. 05 ） ; DNT was significantly shortened （ P 〈 0.01 ） , and the patients who visited the doctors within 60 min of the onset, had the most significantly shortened DNT （P 〈 0.01 ）. In BT group, ODT and DNT showed a significantly negative correlation （r = -0. 169, P = 0. 015 ）, and transient ischemic attack/stroke history （ [3 = - 0. 168, P = 0. 020） and ODT （ [3 = - 0.246, P = 0. 001 ） were independent risk factors affecting the DNT. There was no significant correlation between DNT and ODT （ r = - 0. 013, P = 0. 885 ）. Conclusion The time tracking mode of intravenous thrombolysis may shorten DNT, effectively eliminate the effect of ODT on DNT, and improve the therapeutic effect and prognosis of intravenous thrombolysis for patients with ischemic stroke.