基于微信平台远程指导脑梗死患者静脉溶栓的应用研究

Application of remote guidance of intravenous thrombolysis based on WeChat platform in patients with acute cerebral infarction

目的探讨基于微信平台远程指导脑梗死患者静脉溶栓治疗的可行性。方法收集2017年1月至2019年1月3家基层医院(浙江省金华市金东区中医院、浙江省金华市婺城区人民医院、中国水利水电第十二局有限公司医院)收治的26例基于微信平台行远程指导静脉溶栓治疗的急性脑梗死患者(观察组)和28例3家基层医院转入浙江中医药大学附属金华中医院行静脉溶栓治疗的急性脑梗死患者(对照组)。记录两组发病至就诊时间(ODT)、发病至溶栓时间(ONT)和就诊至溶栓时间(DNT);治疗前和治疗后7 d采用美国国立卫生研究院卒中量表(NIHSS)进行评估;治疗后90 d采用改良Rankin量表(mRS)评估预后;以溶栓治疗24 h内脑出血转变发生率和90 d病死率评估治疗安全性。结果观察组ODT和ONT明显短于对照组[(67.88±20.57)min比(100.57±20.11)min和(131.46±27.76)min比(151.32±31.51)min],DNT明显长于对照组[(63.58±15.49)min比(50.75±13.17)min],差异有统计学意义(P<0.01或<0.05);两组治疗前和治疗后7 d NIHSS评分比较差异无统计学意义(P>0.05);两组脑出血转变发生率和病死率比较差异无统计学意义(P>0.05)。治疗后90 d,观察组预后良好率明显高于对照组[69.2%(18/26)比39.3%(11/28)],差异有统计学意义(P<0.05)。结论基于微信平台远程指导脑梗死患者静脉溶栓可提高溶栓率,缩短发病至溶栓时间,改善患者的远期预后,但与卒中中心相比,基层医院的院内溶栓流程有待优化。

Objective To explore the feasibility of remote intravenous thrombolysis guidance based on WeChat platform in patients with acute cerebral infarction.Methods From January 2017 to January 2019,26 acute cerebral infarction patients treated with remote intravenous thrombolysis guidance based on WeChat platform in 3 primary hospitals(Jindong District Traditional Chinese Medical Hospital of Jinhua City,Zhejiang Province;Wucheng District People′s Hospital of Jinhua City,Zhejiang Province;Hospital of China Water Resources and Hydropower Bureau No.12 Company Limited)were selected as observation group,and 28 acute cerebral infarction patients treated with intravenous thrombolysis who transferred to Jinhua Hospital of Traditional Chinese Medical,Affiliated to Zhejiang Chinese Medicine University by these 3 primary hospitals were selected as control group.The onset-to-door time(ODT),onset-to-needle time(ONT)and door-to-needle time(DNT)were recorded;National Institutes of Health Stroke scale(NIHSS)was recorded before treatment and 7 d after treatment;90 d after treatment,the prognosis was evaluated by modified Randkin scale(mRS);the safety was evaluated by the incidence of intracerebral hemorrhage within 24 h and the mortality of 90 d after treatment.Results The ODT and ONT in observation group were significantly shorter than those in control group:(67.88±20.57)min vs.(100.57±20.11)min and(131.46±27.76)min vs.(151.32±31.51)min,the DNT was significantly longer than that in control group:(63.58±15.49)min vs.(50.75±13.17)min,and there were statistical differences(P<0.01 or<0.05);there was no statistical differences in NIHSS score before treatment and 7 d after treatment between 2 groups(P>0.05);there were no statistical difference in the incidences of intracerebral hemorrhage and mortality between 2 groups(P>0.05).Ninety days after treatment,the rate of good prognosis in observation group was better than that in control group:69.2%(18/26)vs.39.3%(11/28),and there was statistical difference(P<0.05).Conclusions Remote guidance intravenous thrombolysis based on WeChat platform in patients with acute cerebral infarction can improve the thrombolysis rate,shorten ONT and significantly improve the long-term prognosis.But compared with that of advanced stroke centers,the thrombolysis process of primary hospital needs to be optimized.