多学科协作模式改变缺血性卒中超早期重组组织型纤溶酶原激活剂静脉溶栓的预后

Multiple disciplinary team model improves the effect of rt-PA intravenous thrombolytic therapy in patients with acute ischemic stroke

目的 探讨多学科协作（MDT）模式下急性缺血性卒中（AIS）超早期重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓标准化诊疗流程实施的效果。 方法 将164例rt-PA静脉溶栓治疗的超早期AIS患者纳入研究,其中MDT模式下rt-PA静脉溶栓标准化诊疗流程实施前34例被设为实施前组,实施后130例被设为实施后组。对比分析两组患者到达医院至溶栓治疗时间（DNT）、美国国立卫生研究院卒中量表（NIHSS）评分和改良Rankin量表（mRS）评分及溶栓流程中各个环节（患者到达急诊至电话启动溶栓流程、神经内科住院总医师接诊患者、开始CT扫描和签署知情同意书）的用时情况。 结果 DNT均值由标准化流程实施前的111.76±24.84 min缩短到标准化流程实施后的81.31±15.13 min,差异具有统计学意义（P＜0.001）。溶栓治疗前两组患者NIHSS评分对比差异无统计学意义（P＞0.05）,治疗后两组患者NIHSS评分均较治疗前显著改善（P＜0.01）,实施后组患者出院时NIHSS评分及mRS评分较实施前组明显降低（P＜0.01）。实施前后两组患者急诊至开始CT扫描时间比较差异无统计学意义（P＞0.05）；但实施后组患者到达急诊至电话启动溶栓流程时间、患者到达急诊至神经内科住院总医师接诊患者时间和患者到达急诊至签署知情同意书时间均显著低于实施前组（P＜0.01）。 结论 MDT模式下rt-PA静脉溶栓标准化诊疗流程的实施有助于缩短DNT,提高静脉溶栓治疗效果和改善预后。

Aim To investigate the effect on implementation of standard procedure of recombinant tissue-type plasminogen activator （rt-PA） intravenous thrombolysis in patients with acute ischemic stroke （AIS）. Methods One hundred and sixty-four AIS patients were enrolled in this study. Thirty-four cases were assigned into the before-implementation group and one hundred and thirty into the after-implementation group. Door-to-needle time （DNT）, NIHSS scores and modified Rankin scale （mRS） scores of the patients in the two groups were analyzed. The durations of every step in the treatment procedure were statistically compared between the two groups. Results The average DNT in the after-implementation group [（81.31±15.13） min] was significantly shorter than that in the before-implementation group [（111.76±24.84） min] （P〈0.001）. The discharge NIHSS scores declined remarkably compared with baseline NIHSS scores in both two groups, and the difference had statistical significance （P〈0.01）. The discharge NIHSS scores and mRS scores in the after-implementation group was significantly lower than that in the before-implementation group （P〈0.01）. The time interval between arrival at emergent department and beginning CT scan in the two groups was not statistically significant. The time interval between arrival at emergent department and starting the procedure by telephone, consulting chief resident physician and signing the informed consents were significantly shorter in the after-implementation group （P〈0.01）. Conclusion Implementing MDT model of rt-PA intravenous thrombolysis standarding procedure contributes to shortening the DNT and improving the therapeutic effects.