院内缺血性卒中患者未溶栓原因分析

目的分析院内缺血性脑卒中患者未进行溶栓治疗的原因及提出改进对策。方法回顾性分析2010年1月至2016年1月在本院各病区住院期间发生缺血性脑卒中的76例患者病例资料，对急性脑梗死患者未进行溶栓治疗的原因进行统计及分析。结果院内缺血性卒中患者NIHSS评分高于院外缺血性卒中，且有较高致死率。76例缺血性脑卒中患者，24例（31．6％）发生在手术后2周内，12例（15．8％）为静止性卒中或非特异性症状而延迟诊断，10例（13．2％）为溶栓药物禁忌，7例（9．2％）为卒中较轻未溶栓。剩余23例（30.3％）有指征行溶栓者，9例（11．8％）在4．5h时间窗内发现，其中3例（3．9％）行溶栓治疗。院内缺血性卒中的发现主要为医护人员。结论本院近2／3院内缺血性卒中未溶栓与围手术期、静止性卒中或卒中较轻及溶栓药物禁忌有关，院内卒中发现率低是造成溶栓率低的另一方面。

Objective This study analyze the possible barriers to intravenous tissue plasminogen activator （ iv-tPA ） use in patients who have ischemic stroke while hospitahzed for other conditions, in order to propose the way to improvement measures. Methods The medical records of the 76 inpatients with ischemic stroke were collected retropectively in each wards of hospital from January 2010 to January 201 ＆The causes of acute ischemic stroke patients who were barriers to iv-tPA use were calculated and analyzed. Results The patients in-hospital ischemic stroke have high NIHSS score and mortality than the out-hospital ischemic stroke, 76 in-hospital ischemic stroke causes were identified, 24 （31.6%） occurred〈2 weeks after major surgery, while 12 （ 15.8% ） had a delayed diagnosed because signs were not easily detectable and non-specific symptoms on clinical examination. 10 （ 13.2% ） had medical contradications to iv-tPA, and 7 （9.2%） patients were exclusion from thrombolvtic therapy because of mild stroke.23 （ 30.3% ） Patients were eligible for iv-tPA, of whom 9 （ 11.8% ） were identified within 4.5 hours of onset and 3 （ 3.9% ） were treated with iv-tPA. Conclusion 2/3 patients of in-hospital ischemic stroke in our hospital were not thrombolysis, which was accociate with postoperative, clinically subtle, mild stroke , or hadcontraindications toiv-tPA. On the other hand, The low ofthrombolysiswas causedby delayed in stroke discovery.