专职卒中救治团队对急性脑梗死静脉溶栓及介入取栓质量的影响

Effect of full-time stroke treatment team on the quality of intravenous thrombolysis and interventional thrombectomy for acute cerebral infarction

目的探讨专职卒中救治团队对急性脑梗死静脉溶栓及介入取栓治疗质量的影响。方法回顾性连续纳入济宁医学院附属医院经卒中绿色通道给予静脉溶栓和介入取栓治疗的急性脑梗死患者为研究对象,其中对照组纳入2018年6月1日至2020月5月31日即专职卒中救治团队成立前的2年内收治的急性脑梗死静脉溶栓患者355例及介入取栓患者85例;2020年6月1日开始成立专职卒中救治团队,由脑血管病专业方向的神经内科医师、神经外科医师、急诊护士及神经内外科护士组成,有全职科主任和护士长,独立的病房,专门收治需静脉溶栓和(或)介入取栓治疗的超急性期脑梗死患者,以自成立专职卒中救治团队至2022年5月31日2年内收治的急性脑梗死静脉溶栓患者757例及介入取栓患者277例为观察组。比较两组患者静脉溶栓率、就诊至开始静脉溶栓治疗的时间(DNT)、就诊至介入取栓股动脉穿刺时间(DPT)、DNT≤60 min达标率、DPT≤90 min达标率、静脉溶栓并发症发生率、介入取栓并发症发生率、介入取栓患者住院病死率、介入取栓血管再通率等。结果观察组及对照组静脉溶栓及介入取栓患者年龄、性别、高血压病、糖尿病、冠心病、吸烟、饮酒等基线资料差异均无统计学意义(均P>0.05);对照组急性脑梗死静脉溶栓患者355例,同期首诊的发病14 d内住院脑梗死患者为5877例,静脉溶栓率为6.0%;观察组急性脑梗死静脉溶栓患者为757例,同期首诊的发病14 d内住院脑梗死患者为7306例,静脉溶栓率为10.4%;观察组静脉溶栓率明显高于对照组(χ^(2)=8.826,P<0.01)。观察组静脉溶栓DNT为(44±23)min,较对照组DNT[(55±25)min]明显缩短,组间差异有统计学意义(t=3.386,P<0.01);对照组DNT≤60 min达标率为51.5%(183/355),观察组DNT≤60 min达标率为69.4%(525/757),组间差异有统计学意义(χ^(2)=9.954,P<0.01)。对照组静脉溶栓发生并发症共15例,分别为症状性颅内出血2例,消化道出血8例,尿道出血2例,舌体出血2例,口唇肿胀1例,并发症发生率为4.2%;观察组静脉溶栓并发症共21例,分别为症状性颅内出血5例,消化道出血15例,尿道出血1例,并发症发生率为2.8%;观察组静脉溶栓并发症发生率较对照组低,差异有统计学意义(χ^(2)=7.778,P<0.01)。观察组介入取栓DPT为(86±30)min,较对照组DPT[(96±27)min]有缩短,两组差异有统计学意义(t=6.604,P<0.01);对照组DPT≤90 min达标率为40.0%(34/85),观察组DPT≤90 min达标率为50.9%(141/277),组间差异有统计学意义(χ^(2)=10.362,P<0.01)。对照组介入取栓并发症共发生7例,分别为症状性颅内出血5例、动脉夹层1例和血管再栓塞1例,发生率为8.2%;观察组介入取栓并发症共发生9例,分别为症状性颅内出血6例、动脉夹层1例、再灌注损伤1例和血管再栓塞1例,发生率为3.3%;两组差异有统计学意义(χ^(2)=6.351,P<0.01)。观察组介入取栓治疗患者病死率为2.5%(7/277),低于对照组病死率5.9%(5/85),两组差异有统计学意义(χ^(2)=6.002,P<0.01);观察组介入取栓血管再通率为93.9%(260/277),高于对照组介入取栓再通率[85.9%(73/85)],差异有统计学意义(χ^(2)=10.726,P<0.01)。结论专职卒中救治团队能有效地提高急性脑梗死患者静脉溶栓率,缩短DNT、DPT,并降低介入取栓并发症发生率,降低静脉溶栓及介入取栓患者住院病死率,提高介入取栓血管再通率,提高急性脑梗死救治质量。

Objective To explore the effect of establishing a full-time stroke treatment team on the quality of intravenous thrombolysis and interventional thrombectomy for acute cerebral infarction.Methods Patients with acute cerebral infarction who received intravenous thrombolysis and interventional thrombectomy through stroke green channel in Department of Neurology,Affiliated Hospital of Jining Medical University were retrospectively and consecutively selected as the research objects.Among them,355 patients with acute cerebral infarction treated with intravenous thrombolysis and 85 patients with interventional thrombectomy within 2 years before the establishment of the full-time stroke treatment team from June 1,2018 to May 31,2020 were selected as the control group.On June 1,2020,the full-time stroke treatment team was established composed of neurologist,neurosurgeons,emergency nurses and neurological nurses major on the cerebrovascular disease.Professional direction of a full-time department director,head nurse,and independent ward,specialized for treatment and intravenous thrombolysis and(or)the thrombolysis treatment of hyperacute cerebral infarction patients.Since the establishment of full-time stroke treatment team to May 31,2022,757 acute cerebral infarction cases for intravenous thrombolysis and 277 cases for interventional thrombectomy were enrolled as the observation group.Referring to the requirements of China Cerebrovascular Disease Big Data Platform for stroke center related quality control indicators,the study compared the rate of intravenous thrombolysis,door to needle time(DNT),door to puncture time(DPT),compliance rate of DNT≤60 minutes,compliance rate of DPT≤90 minutes,complication rate of intravenous thrombolysis,complication rate of interventional thrombectomy,in-hospital mortality of patients with interventional thrombectomy,and recanalization rate of interventional thrombectomy.Results There were no significant differences in age,gender,hypertension,diabetes,coronary heart disease,smoking,drinking and other baseline data between the observation group and the control group(all P>0.05).There were 355 patients with acute cerebral infarction treated with intravenous thrombolysis in the control group,and 5877 patients with cerebral infarction within 14 days of onset of the first visit during the same period,so the intravenous thrombolysis rate of the control group was 6.0%;and 757 patients with acute cerebral infarction treated with intravenous thrombolysis within 2 years after the establishment of a full-time stroke treatment team in the observation group.During this period,there were 7306 hospitalized patients with cerebral infarction within 14 days of the first diagnosis,so the intravenous thrombolysis rate of the observation group was 10.4%,which was significantly higher than that of the control group,with statistically significant difference(χ^(2)=8.826,P<0.01).The DNT of intravenous thrombolysis in the observation group was(44±23)min,which was significantly shorter than that in the control group([55±25]min),and the difference was statistically significant(t=3.386,P<0.01).The DNT≤60 minutes compliance rate of the control group was 51.5%(183/355),and the DNT≤60 minutes compliance rate of the observation group was 69.4%(525/757),with statistically significant difference between the two groups(χ^(2)=9.954,P<0.01).There were 15 cases of complications in the control group,including 2 cases of symptomatic intracranial hemorrhage,8 cases of gastrointestinal bleeding,2 cases of urethral bleeding,2 cases of tongue bleeding,and 1 case of mouth swelling,with a complication rate of 4.2%.There were 21 cases of complications in the observation group,including 5 cases of symptomatic intracranial hemorrhage,15 cases of gastrointestinal bleeding,and 1 case of urethral bleeding.The incidence of complications was 2.8%.The incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(χ^(2)=7.778,P<0.01).The DPT of intervention thrombectomy in the observation group was(86±30)min,which was shorter than that in the control group([96±27]min),and the difference was statistically significant(t=6.604,P<0.01).The compliance rate of DPT≤90 min in the control group was 40.0%(34/85),and the compliance rate of the observation group was 50.9%(141/277),with statistically significant difference between the two groups(χ^(2)=10.362,P<0.01).There were 7 cases of complications in the control group,including 5 cases of symptomatic intracranial hemorrhage,1 case of arterial dissection and 1 case of vascular re-embolism,with an incidence rate of 8.2%.There were 9 cases of complications in the observation group,including 6 cases of symptomatic intracranial hemorrhage,1 case of arterial dissection,1 case of reperfusion injury and 1 case of vascular re-embolism,with an incidence rate of 3.3%.The difference between the two groups was statistically significant(χ^(2)=6.351,P<0.01).The mortality rate of the observation group was 2.5%(7/277),which was lower than that of the control group 5.9%(5/85),and the difference was statistically significant(χ^(2)=6.002,P<0.01).The recanalization rate of the observation group was 93.9%(260/277),which was higher than 85.9%(73/85)of the control group,and the difference was statistically significant(χ^(2)=10.726,P<0.01).Conclusion The full-time stroke treatment team can effectively improve the rate of intravenous thrombolysis in patients with acute cerebral infarction,shorten the DNT and DPT,reduce the complications of intravenous thrombolysis and interventional thrombectomy,reduce the in-hospital mortality of patients with intravenous thrombolysis and interventional thrombectomy,improve the recanalization rate of interventional thrombectomy,and improve the quality of acute stroke treatment.