急诊创新绿色通道对急性缺血性脑卒中静脉溶栓治疗的应用效果

Application effect of innovative green channel in emergency department in intravenous thrombolysis for acute ischemic stroke

目的观察评价分析急诊绿色通道对急性缺血性脑卒中(AIS)静脉溶栓治疗的应用效果。方法选择2016年2月至2019年10月期间收治急性缺血性脑卒中且接受静脉溶栓治疗的患者95例,对照组53例给予程序优化、流程再造(BPR)和压缩时间且按常规就诊流程给予阿替普酶静脉溶栓治疗;观察组42例程序优化、流程再造(BPR)和压缩时间进行创新绿色通道后给予阿替普酶静脉溶栓治疗,并比较两组的临床效果。结果观察组DNT、平均住院时间及溶栓后7 d NIHSS评分和mRS评分均显著地低于对照组(t=32.5107、5.7638、3.7196、3.6042,均P<0.05);治疗6个月后,观察组总有效率为95.24%,明显高于对照组的77.36%(χ^2=5.9614,P=0.0146);观察组脑出血发生率为4.76%(2/42),对照组为7.55%(4/53),两组比较差异无统计学意义(χ^2=0.3072,P=0.5794),观察组消化道出血发生率为2.38%(1/42),对照组为5.66%(3/53),两组比较差异无统计学意义(χ^2=0.6248,P=0.4293)。结论急诊程序优化、BPR和压缩时间进行创新绿色通道应用于静脉溶栓治疗AIS提高溶栓效果,有效地缩短溶栓前等待时间,大大地减轻神经功能缺损程度,有助于改患者预后,且显著地提高患者的生存质量,值得临床大力推广应用。

Objective To observe and evaluate the effect of emergency green channel on intravenous thrombolytic therapy for acute ischemic stroke(AIS).Methods From February 2016 to October 2019,95 patients with acute ischemic stroke who received intravenous thrombolysis were selected.53 patients in the control group were given routine optimization,process reengineering(BPR),and compression time,and were given usual alteplase intravenous thrombolysis;42 patients in the observation group were given alteplase intravenous thrombolysis after optimizing procedures,process reengineering(BPR),and compression time for innovative green channel.The clinical effects of the two groups were compared.Results The DNT,hospital stay,NIHSS score and mRS score after 7 d of thrombolysis in the observation group were significantly lower than those in the control group(t=32.5107,5.7638,3.7196,3.6042;all P<0.05).After 6 months of treatment,the total effective rate of the observation group was 95.24%,which was significantly higher than that of the control group(77.36%)(χ^2=5.9614,P=0.0146).The incidence of cerebral hemorrhage in the observation group was 4.76%(2/42),that in the control group was 7.55%(4/53)(χ^2=0.3072,P=0.5794);the incidence of gastrointestinal bleeding in the observation group was 2.38%(1/42),that in the control group was 5.66%(3/53)(χ^2=0.6248,P=0.4293).Conclusions The emergency procedure optimization,process reengineering(BPR),and compression time for innovative green channel applied in intravenous thrombolysis for acute ischemic stroke(AIS)improve thrombolytic effect,effectively shorten the waiting time before thrombolysis,greatly reduce the degree of neurologic impairment,is helpful to improve the patients'prognosis,and significantly improve the patients'quality of life,which is worthy of clinical application.