院前急救质量改善策略在缺血性脑卒中患者静脉溶栓中的应用

Application of quality improvement strategy of pre-hospital first aid in intravenous thrombolysis of ischemic stroke survivors

目的调查脑卒中溶栓患者院前调度与转运情况,比较开展卒中中心认证进行院前救治质量改善策略前后的溶栓患者获得急救资源的差异及对溶栓结局的影响。方法选取2017年7月—2018年6月(卒中中心认证前)通过EMS救治的97例接受溶栓治疗的缺血性脑卒中患者为常规组,选取2018年8月—2019年6月(卒中中心认证后)通过EMS救治的123例接受溶栓治疗的缺血性脑卒中患者为改善组。常规组采用院前救治措施,改善组在常规组基础上采用院前救治改善策略。比较2组患者在救治时间节点和临床结局方面的差异。结果改善组患者的调度中心派车时间、EMS反应时间、EMS现场时间、入院至静脉溶栓用药时间(door to needle time,DNT)、发病-治疗时间(onset to treatment time,OTT)均明显短于常规组(t=21.528,P<0.001;t=6.221,P<0.001;t=22.243,P<0.001;t=6.769,P<0.001;t=9.124,P<0.001);改善组预后良好率高于常规组(χ^(2)=4.936,P=0.026)。结论卒中优先派遣代码、初步评估,EMS分级响应、院前预警等一系列院前救治改善策略能有效缩短院前延误,改善缺血性脑卒中患者溶栓结局,值得应用推广。

Objective To investigate the pre-hospital scheduling and transportation of stroke patients with thrombolysis,and to compare the difference in the first aid resources and its effect on the outcome of thrombolysis before and after the implementation of quality improvement strategy of pre-hospital treatment.Methods Totally 97 patients with ischemic stroke treated between July 2017 and June 2018 were selected into a routine group,while another 123 counterparts treated in August 2018 and Six 2019 were chosen into an intervention group.Both groups were given pre-hospital treatment,while the intervention group was additionally provided with improved pre-hospital treatment.The time of being rescued and clinical outcome of the two groups were compared.Results The dispatch time,EMS reaction time,EMS field time,door to needle time,and onset to treatment time of the intervention group were significantly shorter than those of the routine group(t=21.528,P<0.001;t=6.221,P<0.001;t=22.243,P<0.001;t=6.769,P<0.001;t=9.124,P<0.001).The clinical outcome of the intervention group was significantly better than that of the control group(χ^(2)=4.936,P=0.026).Conclusions The improvement on the pre-hospital treatment can significantly relieve the pre-hospital delay and improve the outcome of thrombolysis,which is worth popularizing in the clinical practice.