急诊"零通道"模式在提高脑卒中静脉溶栓效率中的效果研究

Effect of emergency"zero channel"process on improving efficiency of intravenous thrombolysis in stroke

目的探讨急诊"零通道"模式在急性缺血性脑卒中静脉溶栓治疗中的应用效果。方法选择南方医科大学珠江医院急诊科自2020年1月至2020年12月收治的58例急性缺血性脑卒中患者为研究组,自2019年1月至2019年12月收治的58例年龄、性别分布等基线资料与研究组匹配的急性缺血性脑卒中患者为对照组。对照组采用急诊"绿色通道"流程;研究组采用进一步优化流程后的"零通道"模式,即将救治工作通道前移至救护车中。采用入院-入抢救室时间(DRRT)、入院-会诊时间(DCT)、入院-实验室检查完成时间(DLECT)、入院-获取CT报告时间(DCRT)、入院-给予静脉溶栓时间(DNT)评价2组患者急诊服务时间;采用闭塞血管成功再通率、溶栓有效率评价2组患者溶栓效果;采用改良Rankin量表(mRS)评分评价2组患者治疗后6个月时预后(mRS评分≤2分定义为预后良好)。结果研究组患者DCRT、DCT与DNT较对照组患者明显缩短,DNT达标(≤60 min)率较对照组明显升高,差异均有统计学意义(P<0.05)。研究组、对照组患者溶栓后即刻闭塞血管成功再通率分别为60.3%、27.6%,溶栓有效率分别为94.83%、82.76%,差异均有统计学意义(χ^(2)=12.633,P<0.001;χ^(2)=4.245,P=0.039)。随访6个月,研究组、对照组预后良好率分别为36.2%、15.5%,差异有统计学意义(χ^(2)=4.016,P=0.041)。结论急诊"零通道"模式能进一步缩短DCT、DCRT、DNT,提高患者静脉溶栓有效率,改善预后。

Objective To explore the effect of emergency"zero channel"process on improving the efficiency of intravenous thrombolysis in stroke.Methods Fifty-eight acute ischemic stroke patients admitted to our hospital from January 2020 to December 2020 were enrolled into experimental group;another 58 acute ischemic stroke patients admitted to our hospital from January 2019 to December 2019 and matched with age and gender were selected as control group."Green channel"process was adopted for patients in the control group,and optimized"zero channel"process(moving the working passageway forward to the ambulance)was implemented for patients in the experimental group.Door to rescue room time(DRRT),door to consultation time(DCT),door to laboratory examination completion time(DLECT),door to CT report time(DCRT),and door to needle time(DNT)were used to evaluate the times of emergency treatment.The thrombolytic effect of the two groups was compared by evaluating the recanalization rate of occluded vessels and thrombolytic efficiency.Modified Rankin scale(mRS)was used to evaluate the prognoses 6 months after treatment in both groups,and mRS scores≤2 was defined as good prognosis.Results The DCRT,DCT and DNT in the experimental group were significantly shorter than those in the control group(P<0.05);the compliance rate of DNT≤60 min in the experimental group was significantly higher as compared with that in the control group(P<0.05).The immediate recanalization rate of occluded vessels in the experimental group and control group was 60.3%and 27.6%,and the thrombolytic efficiency was94.83%and 82.76%;significant differences were noted between the two groups(χ^(2)=12.633,P<0.001;χ^(2)=4.245,P=0.039).The good prognosis rate of the experimental group and control group was 36.2%and 15.5%,respectively,after 6 months of follow-up(χ^(2)=4.016,P=0.041).Conclusion Emergency"zero channel"can further shorten DCT,DCRT,and DNT,and improve the efficiency of thrombolysis and prognoses of acute ischemic stroke patients.