急性脑梗死静脉溶栓流程优化

Optimizing Thrombolytic Procedures in Acute Ischemic Stroke

目的观察加强流程管控对降低急性脑梗死患者静脉溶栓前院内时间延误(Door-to-needle time,DNT)的影响。方法自2012年初起,采取多种管理措施对静脉溶栓流程进行改造,对改造前后的DNT、DNT≤60分钟比例等指标进行对比研究。结果流程改造前共收治静脉溶栓患者41例,中位年龄为67.5岁(四分位数范围:60~77.5岁);流程改造后3年内共收治静脉溶栓患者380例,中位年龄75岁(63~83岁),较改造前明显增加(P<0.01)。流程改造后,DNT中位数由109分钟(68~148分钟)降至69分钟(41~97分钟)(P<0.01);DNT≤60分钟比例由9.8%提高至43.2%(P<0.01)。结论加强优化溶栓流程的管理,可使溶栓患者数量明显增加,院内延误大幅降低。

Objective To observe the change of in - hospital delays （ door - to - needle time, DNT） in the patients with acute ischemic stroke after quality control （QC） in process optimization of thrombolytie procedures. Methods Since Jan 2012, a series of procedure interventions to reduce thrombolytic delays were implemen- ted. The rate of DNT ≤60 minutes and median DNT were analyzed. Results Before 2012, a total of 41 patients received intravenous thrombolytic therapy. The median age was 67.5 years old （interquartile range IQR 60 - 77.5 ）. In 3 year - period after 2012, 380 patients with acute cerebral infarction were admitted and lysis. Their median age （75, IQR 63 -83 ） was older than that before 2012. Median DNT was reduced from 109 minutes （IQR 68 - 148） to 69 minutes （IQR 41 -97） （P 〈0.01 ） and Rate of DNT~〈60 minutes was increased from 9.8% to 43.2% （P 〈 0.01 ） after new optimized procedures been carried out. Conclusion QC on optimization of thrombolytic procedures was associated with improvement in the timeliness of tPA administration and increased the number of patients who can obtain the benefits from thromholysis.