卒中院内流程优化对高龄急性脑梗死溶栓治疗的价值

Effect of optimized intra-hospital process on thrombolytic therapy in elderly patients with acute cerebral infraction

目的探讨卒中院内流程优化对高龄人群地区急性脑梗死溶栓治疗的价值。方法回顾性收集博罗县人民医院2014年1月—2020年5月行静脉溶栓治疗的年龄≥80岁急性脑梗死患者资料。按卒中院内优化流程前后,分为对照组和优化组。比较两组患者的溶栓后24 h、出院时(NIHSS)评分、DNT时间(即患者就诊到静脉溶栓药物开始使用时间)、OTT时间(即患者发病到静脉溶栓药物开始使用时间)、治疗后24 h出血性脑梗死转化率、患者住院时间、治疗结局(溶栓后90天mRS评分)。结果共纳入73例≥80岁急性脑梗死患者,年龄80~91岁,平均83.13岁;男性31例(42.46%)。其中对照组44例,优化组29例。对两组患者的一般资料进行比较其差异无统计学意义(P>0.05)。优化组溶栓后24 h以及出院时NIHSS评分,分别为(9.83±5.98)、(7.17±5.93)分,低于对照组的(12.93±5.96)、(10.30±5.58)分,差异均有统计学意义(P<0.05)。优化组患者DNT、OTT、住院时间、出院后90天mRS评分低于对照组,DNT<60 min所占比例高于对照组,差异均有统计学意义(P<0.05)。结论实施院内优化流程后,年龄≥80岁的高龄急性脑梗死患者行静脉溶栓治疗后其神经功能恢复更佳,能缩短患者住院时间,显著降低患者致残率,值得进行临床推广应用。

Objective To investigate effect of optimized intra-hospital process on thrombolytic therapy in patients with acute cerebral infraction.Methods Data of patients aged over 80 with acute cerebral infarction who underwent intravenous thrombolytic therapy in Boluo County People′s Hospital from January 2014 to May 2020 were collected retrospectively.The patients were divided into control group and optimization group before and after the intra-hospital process was optimized.NIHSS scores at 24 hours after thrombolysis and at discharge from hospital,DTN time(the time to start intravenous thrombolytic therapy),OTT time(the time from onset of symptoms to initiation of intravenous thrombolytic therapy),conversion rate of hemorrhagic cerebral infarction at 24 hours after treatment,hospital stay and treatment outcome(mRS score at 90 days after thrombolysis)were compared between the two groups.Results A total of 73 patients,aged from 80 years to 91 years old,averaged 83.13 years,were included in the study.Thirty-one of them were male(42.46%).There were 44 patients in the control group and 29 patients in the optimization group.No statistical difference in the general data was found between the two groups(P>0.05).The NIHSS scores of the optimization group 24 h after thrombolysis and at discharge were significantly lower than those of the control group,respectively(9.83±5.98 vs.12.93±5.96;7.17±5.93 vs.10.30±5.58;P<0.05).The DNT,OTT,hospital stay,and mRS score 90 days after discharge were significantly lower and the proportion of DNT<60 min was significantly higher than that of the control group(P<0.05).Conclusion After intra-hospital process was optimized,elderly patients with acute cerebral infarction aged≥80 years have better neurological recovery after intravenous thrombolytic therapy,shortening hospital stay and significantly reducing the disability rate of the patients.It is worthy of being widely popularized in the clinical application.