院前-院内无缝急救模式对急性脑梗死患者阿替普酶静脉溶栓治疗的疗效影响

Effect of seamless pre-hospital-in-hospital emergency mode on the efficacy of intravenous thrombolysis with alteplase in patients with acute cerebral infarction

目的 探讨院前-院内无缝急救模式对急性脑梗死患者阿替普酶静脉溶栓治疗的疗效影响。方法 选取2020年10月~2022年10月某院急诊收治的78例行阿替普酶静脉溶栓治疗的急性脑梗死患者为研究对象,依据急救模式不同分为两组,试验组(120接诊院前-院内无缝急救,37例)和对照组(自行入院常规院内急救,41例)。统计两组急诊救治成功率;比较观察两组入院至接诊、CT检查、实验室检查、静脉溶栓四项急诊救治工作所用时间;溶栓后24 h,以美国国立卫生研究院卒中量表(NIHSS)评估两组神经功能缺损改善情况;随访3个月,以改良Rankin量表(mRS)和Bathel指数(BI)评估两组神经功能恢复情况及日常生活能力,评价两组预后。结果 两组均在时间窗内完成了阿替普酶静脉溶栓治疗并生存,急诊救治成功率100%。试验组患者入院至接诊、CT检查、实验室检查、静脉溶栓四项急诊救治工作所用时间均短于对照组,差异有统计学意义(P <0.05)。试验组溶栓后NIHSS评分低于对照组,治疗后随访BI评分高于对照组,m RS≥2分患者占比低于对照组,差异有统计学意义(P <0.05)。结论 基于院前-院内无缝急救模式对急性脑梗死患者进行阿替普酶静脉溶栓治疗,可以有效缩短院内救治时间,提高溶栓治疗效果,在改善患者预后方面更具优势。

Objective To investigate the effect of seamless pre-hospital-in-hospital emergency mode on the efficacy of intravenous thrombolytic therapy with alteplase in patients with acute cerebral infarction.Methods From October 2020 to October 2022,78 patients with acute cerebral infarction treated with intravenous thrombolysis with alteplase admitted to our hospital's emergency department were selected for the study,and they were divided into two groups according to the different emergency modes:the test group(seamless pre-hospital-in-hospital emergency with 120 admissions,37 cases)and the control group(regular in-hospital emergency with self-admission,41 cases).The success rate of emergency treatment in the two groups was counted;the time spent on the four emergency treatment tasks,including admission to the hospital,CT examination,laboratory examination and intravenous thrombolysis was compared;the improvement of neurological deficits in the two groups was assessed by the National Institutes of Health Stroke Scale(NIHSS)24 h after thrombolysis;the modified Rankin Scale(mRS)and Bathel Index(BI)were used to assess the recovery of neurological deficits in the two groups at a follow-up of 3 months.The prognosis of the two groups was evaluated by assessing the recovery of neurological function and the ability of daily living.Results Both groups completed intravenous thrombolytic therapy with alteplase and survived within the time window,with a 100%success rate of emergency treatment.The time spent on the four emergency treatment tasks from admission to reception,CT examination,laboratory examination,and intravenous thrombolysis was shorter in the test group than in the control group,and the difference was statistically significant(P<0.05).The NIHSS score after thrombolysis in the test group was lower than that in the control group,the BI score at post-treatment follow-up was higher than that in the control group,and the proportion of patients with mRS≥2 was lower than that in the control group,with statistically significant differences(P<0.05).Conclusion Intravenous thrombolysis with alteplase in patients with acute cerebral infarction based on a seamless pre-hospital-in-hospital emergency mode can effectively shorten the in-hospital rescue time,improve the effect of thrombolysis treatment,and have more advantages in improving patient prognosis.