基于急救医疗服务体系的急性脑梗死急诊一体化溶栓模式的构建及应用

Construction and application of emergency integrated thrombolytic model for acute cerebral infarction based on emergency medical service system

目的基于急救医疗服务体系构建适用于急性脑梗死(ACI)患者静脉溶栓的“急诊一体化溶栓模式”,并探讨该模式的可行性及效果。方法收集秦皇岛市第一医院2017年5月-2019年6月行静脉溶栓治疗的ACI患者资料。依据是否构建“急诊一体化溶栓模式”,分为试验组和对照组。比较两组患者DNT、出血转化率、预后。结果共纳入386例ACI患者,其中对照组176例,优化组210例。两组患者一般资料比较差异无统计学意义。两组患者24h颅内出血转化率差异无统计学意义(P>0.05)。与对照组比较,观察组DNT缩短[(67.50±10.06)min比(87.66±19.11)min,P<0.05],DNT<60 min的患者比例更高[61(29.04%)vs 28(15.90%),P<0.05];溶栓后90d预后良好(mRS评分≤2分)患者比例更高[89(42.38%)vs 46(26.14),P=0.001]。结论基于整体急救医疗服务体系的“急诊一体化溶栓模式”有效减少了院内延误,安全可行,明显改善患者预后,值得在基层医院临床推广应用。

Objective Based on the Emergency Medical Service System,an“Emergency Integrated Thrombolytic Model”suitable for intravenous thrombolysis in patients with acute cerebral infarction(ACI)was constructed and the feasibility and ffct of this model were discussed.Methods The data of ACI patients who received intravenous thrombolysis in our hospital from May 2017 to June 2019 were collected.According to whether to establish"Emergency Integrated Thrombolytie Model",they were divided into experimental group and control group.DNT,bleeding conversion rate and prognosis of the two groups were compared.Results A total of 386 ACI patients were included,including 176 in the con-trol group and 210 in the optimized group.There was no significant difference in general information between the two groups of patients.There was no significant difference in the intracranial hemorrhage conversion rate between the two groups of patients(P>0.05).Compared with the control group,the DNT in the observation group was shortened[(67.50±10.06)min vs.(87.66±19.11)min,P<0.05],and the proportion of patients with DNT≤60 min was higher[61(29.04%)vs.28(15.90%),P<0.05];The prognosis was good at 90 days after thrombolysis(mRS score≤2 points)was higher in pa-tients[89(42.38%)vs.46(26.14%),P=0.001].Conclusion The"Emergency Integrated Thrombolytic Model"based on the Emergency Medical Service System can safely and effectively reduce in-hospital delays and improve the prognosis of patients,which is worthy of clinical promotion and application in primary hospitals.