急诊超急性期脑梗死患者溶栓流程改造的效果研究

Study on the effect of thrombolytic process modification in emergency for hyperacute cerebral infarction

目的通过急诊溶栓流程的改造缩短院内耽误时间。方法回顾性纳入2016年1月至2019年12月本院急诊收治的行静脉溶栓治疗的急性脑梗死患者158例为研究对象,男102例,女56例,年龄(69.12±12.75)岁。本院自2017年11月起采取一系列措施进行急诊溶栓流程的改造,包括在急诊设立卒中专科护士岗位、溶栓地点由病房前移到急诊、完善卒中绿色通道、优化评判溶栓路径等。建立3个时间节点:入急诊到扫描头颅CT的时间,扫描头颅CT到签署知情同意的时间,签署知情同意到开始溶栓的时间。3个时间相加得到急诊至开始静脉溶栓时间(door to needle time,DNT)。评价各时间节点、DNT、溶栓达标率(DNT≤60 min为达标)的情况,进而分析院内延误改进的效果。结果2016—2019年4年间,经急诊溶栓的例数分别是20例、22例、46例、70例;溶栓达标率分别为5.00%、9.09%、43.49%、55.71%;DNT中位数分别为112.0(82.5,134.0)min、75.5(71.8,85.0)min、67.5(48.8,82.3)min、59.0(49.8,76.0)min。各年度的时间节点和DNT均逐年缩短,除扫描头颅CT到签署知情同意的时间以外(P=0.260),其余各项比较差异均有统计学意义(均P<0.05)。结论本院急诊溶栓流程改造方法效果显著,值得推广。

Objective To shorten the delay time in hospital through the transformation of emergency thrombolysis process.Methods A total of 158 patients with acute cerebral infarction who underwent intravenous thrombolysis in EmergencyDepartment of our hospital fromJanuary 2016 to December 2019were selected as the research objects,including 102males,56 females,aged(69.12±12.75).Since November 2017,our hospital had taken a series of measures to transform the emergency thrombolysis process,including setting up stroke specialist nurses in the emergency department,moving the thrombolysis place from the ward to the emergency department,improving the stroke green channel,optimizing the thrombolysis path,etc.Three time points were established:the time from emergency admission to skull CT scanning,the time from skull CT scanning to signing informed consent,and the time from signing informed consent to thrombolysis,the sum of the three as door to needle time(DNT).Three time points,DNT,and thrombolytic control rate(DNT≤60 minutes)were analyzed.And then the improvement effect of in-hospital delay was analyzed.Results In the four years from 2016 to 2019,the number of cases of emergency thrombolysis was 20,22,46,and 70,respectively;the thrombolytic control rate was 5.00%,9.09%,43.49%,and 55.71%,respectively;the median DNT was 112.0(82.5,134.0)min,75.5(71.8,85.0)min,67.5(48.8,82.3)min,59.0(49.8,76.0)min,respectively.In the four years,the time nodes and DNT were shortened year by year;except for the time from skull CT scanning to signing informed consent(P=0.260),there were statistically significant differences in the other indicators(all P<0.05).Conclusion The transformation method of emergency thrombolysis process in our hospital has remarkable effect and is worth popularizing.