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Preliminary Study on the Optimization Effect of Intravenous Thrombolysis in Acute Ischemic Stroke in Lhasa
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摘要:
目的 探索优化卒中绿色通道救治流程对提高拉萨市急性缺血性脑卒中(acute ischemic stroke，AIS)溶栓质量的效果。 方法 回顾性纳入2019年8月—2021年12月西藏自治区卒中中心连续上报的采用重组组织型纤溶酶原激活剂静脉溶栓的所有AIS患者。按照患者就诊时卒中绿色通道救治流程是否优化，将其分为优化前组(2019年8月—2021年6月)、优化后组(2021年7—12月)。比较两组静脉溶栓质量及患者预后。 结果 共纳入34例接受静脉溶栓治疗的AIS患者(平均每月溶栓1.2例)，其中优化前组16例、优化后组18例。基线、溶栓后即刻、溶栓后24 h美国国立卫生研究院卒中量表评分分别为6.5(3.0, 12.0)分、3.0(1.0, 5.5)分、2.0(0, 6.3)分。与优化前组比较，优化后组入院至静脉溶栓时间显著缩短[(67.1±37.8)min比(108.9±53.8)min, P=0.035]，发病至静脉溶栓时间[(176.7±69.7)min比(199.1±47.8)min, P=0.065]、入院至静脉溶栓时间≤60 min达标率(50.0%比18.8%，P=0.061)、溶栓短期疗效良好患者占比(77.8%比62.5%，P=0.336)数值均有所改善，但差异无统计学意义。 结论 优化西藏自治区卒中中心绿色通道救治流程后，拉萨市静脉溶栓AIS患者的院内救治时间明显缩短，有助于提高AIS早期治疗的急救效率。 Abstract:Objective To explore the improvement effect of green channel process optimization in acute ischemic stroke (AIS) on intravenous thrombolysis (IVT) quality in Lhasa. Methods All patients with AIS who received IVT by the stroke center of Tibet Autonomous Region from August 2019 to December 2021 were included. According to whether the stroke green channel process was optimized, they were divided into the pre-optimization group (August 2019 to June 2021) and the post-optimization group (July to December 2021). The quality of IVT and stroke prognosis were compared and analyzed between the two groups. Results A total of 34 patients with AIS who received IVT were included (an average of 1.2 patients per month), including 16 in the pre-optimization group and 18 in the post-optimization group. The National Institutes of Health Stroke Scale scores at baseline, immediately after thrombolysis, and 24 hours after thrombolysis were 6.5(3.0, 12.0), 3.0(1.0, 5.5)and 2.0(0, 6.3), respectively. The door to needle time in the post-optimization group was significantly shortened, as compared with that of the pre-optimization group[(67.1±37.8)min vs. (108.9±53.8)min, P=0.035]. Onset to needle time [(176.7±69.7)min vs. (199.1±47.8)min, P=0.065], the compliance rate of door to needle time ≤60 min (50.0% vs. 18.8%, P=0.061) and the proportion of good short-term efficacy of thrombolysis (77.8% vs. 62.5%, P=0.336) were improved, but the differences were not statistically significant. Conclusions After the process optimization of stroke green channel, the in-hospital delay of IVT for AIS in Lhasa is significantly improved, which is helpful to enhance the first-aid efficiency of early treatment of AIS. -
Key words:
- acute ischemic stroke /
- process optimization /
- thrombolysis /
- stroke center of Tibet
作者贡献：周立新、次央负责论文撰写、修订；胡亚雄、卓玛负责数据收集；次旦卓嘎、王栋梁、曹旭东、吴科学负责论文修订；赵玉华、彭斌负责论文审校。利益冲突：所有作者均声明不存在利益冲突 -
表 1 卒中救治流程优化前后两组患者的临床资料比较
指标 优化前组(n=16) 优化后组(n=18) 男性[n(%)] 8(50.0) 15(83.3) 年龄(x±s, 岁) 60.2±15.8 52.6±13.1 藏族[n(%)] 9(56.3) 11(61.1) 基线NIHSS评分[M(P25, P75), 分] 7.0(4.0, 12.0) 6.0(2.3, 10.8) TOAST分型[n(%)] 大动脉粥样硬化 10(62.5) 4(22.2) 心源性栓塞 3(18.8) 5(27.8) 脑小血管病 1(6.3) 2(11.1) 其他病因 0(0) 2(11.1) 原因未明 2(12.5) 5(27.8) NIHSS：同图 1 
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表 2 卒中救治流程优化前后两组静脉溶栓流程质量及预后指标比较
指标 优化前组(n=16) 优化后组(n=18) 差值(95% CI) P值 ONT(x±s，min) 199.1±47.8 176.7±69.7 -22.4(-19.83~64.75) 0.065 DNT(x±s，min) 108.9±53.8 67.1±37.8 -41.8(11.30~72.24) 0.035 DNT≤60 min达标率(%) 18.8 50.0 0.061 溶栓短期疗效良好[n(%)] 10(62.5) 14(77.8) 0.336 出血转化[n(%)] 2(12.5) 3(16.7) 0.736 住院时间(x±s，d) 9.4±5.1 9.9±7.2 0.5(-4.96~3.95) 0.800 NIHSS：同图 1；ONT：发病至静脉溶栓时间；DNT：入院至静脉溶栓时间
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