优化院前院内卒中一体化管理模式对急性脑梗死静脉溶栓患者预后的影响

Effects of Improvement of Pre-hospital and Intra-hospital Management on Prognosis of Patients with Acute Venous Cerebral Infarction

目的探讨优化院前院内卒中一体化管理模式对急性脑梗死静脉溶栓患者预后的影响。方法采用前后匹配病例对照研究,将2013年1月—2014年8月入院且接受静脉溶栓的急性脑梗死60例纳入干预前组,将制定并实施院前院内卒中一体化管理优化模式后的2014年8月—2015年12月入院且接受静脉溶栓的急性脑梗死31例纳入干预后组。观察症状起始至来院就诊时间(OTD)、到达医院至溶栓治疗开始时间(DTN)、DTN≤60 min所占比例及症状性颅内出血发生率,评估溶栓治疗后24 h美国国立卫生研究院卒中量表(NIHSS)评分,观察神经功能恢复情况及病死率。结果与干预前组比较,干预后组DTN、入院到CT检查时间、入院到完成实验室检查时间缩短,DTN≤60 min所占比例升高,差异有统计学意义(P<0.05),但OTD、溶栓治疗24 h后NIHSS评分、症状性颅内出血发生率、病死率及神经功能评分差异无统计学意义(P>0.05)。结论院前院内卒中一体化管理模式可有效缩短急性脑梗死患者溶栓时间窗,改善预后。

Objective To observe effects of improvement of pre-hospital and intra-hospital management on prognosis of patients with acute venous cereral infarction. Methods Anterior-posterior matching case-control study was used in this study. A total of 60 acute venous cerebral infarction inpatients admitted during January 2013 and August 2014 were selected as before intervention group, and 31 inpatients admitted during August 2014 and December 2015 after making improvement of pre-hospital and intra-hospital management were selected as after intervention group. Time of onset to door （OTD）, time of door to needle （ DTN） ,rate of patients with DTN equal or less than 60 min and incidence rate of intra-cerebral hemorrhage were observed, and national institute of health stroke scale （ NIHSS） scores in 24 h after thrombolysis therapy were evaluated, and conditions of nerval functional rehabilitation and fatality rates were also observed. Results Compared with those in before intervention group, time of DTN, in after intervention group, time of door to CT scan and time of door to finishing laboratory examination were significantly decreased, while the rate of patients with DTN equal or less than 60 min was significantly in-creased （P〈0. 05）, but there were no significant differences in OTD , NIHSS score in 24 h after thrombolysis therapy, inci-dence rate of symptomatic intra-cerebral hemorrhage, fatality rate and nerval function score （P〉0. 05）. Conclusion Im-provement of pre-hospital and intra-hospital management may decrease time from onset of thrombolysis and improve the progno-sis of patients with acute venous cereral infarction.