急诊绿色通道对急性缺血性脑卒中患者阿替普酶静脉溶栓效果的影响

朱慧瑜

[摘要]目的 分析急診绿色通道对急性缺血性脑卒中患者阿替普酶静脉溶栓效果的影响。方法 选取2017年1月～2018年12月于本院急诊科就诊的175例急性缺血性脑卒中患者为研究对象，其中未开通绿色通道的87例作为对照组，开通绿色通道的88例作为观察组，对照组经常规诊疗后给予阿替普酶静脉溶栓治疗，观察组开通绿色通道后给予阿替普酶静脉溶栓治疗，回顾性分析患者临床资料，比较两组患者治疗效果、确诊时间、转送专科时间、入院至溶栓治疗时间（DNT）及静脉溶栓率。结果 观察组的治疗效果明显优于对照组，差异有统计学意义（P<0.05）;观察组确诊时间、转送专科时间及DNT均明显短于对照组，差异有统计学意义（P<0.05）;入院后1、3 h，观察组的静脉溶栓率高于对照组，入院后4.5 h，观察组的静脉溶栓率低于对照组，差异有统计学意义（P<0.05）。结论 对于行阿替普酶静脉溶栓治疗的急性缺血性脑卒中患者，急诊绿色通道的开通可明显改善患者治疗效果，缩短确诊时间、转送专科时间及DNT，提高入院后1、3 h的静脉溶栓率。

[关键词]急诊绿色通道;缺血性脑卒中;阿替普酶;静脉溶栓

[中图分类号] R743.33          [文献标识码] A          [文章编号] 1674-4721（2019）11（a）-0069-03

Effect of emergency green channel on Alteplase used for intravenous thrombolysis in patients with acute ischemic stroke

ZHU Hui-yu

Department of Emergency， Guangzhou First People′s Hospital， Guangdong Province， Guangzhou   510180， China

[Abstract] Objective To analyze the effect of emergency green channel on the intravenous thrombolyis of Alteplase in patients with acute ischemic stroke. Methods A total of 175 patients with acute ischemic stroke who were admitted to the Department of Emergency from January 2017 to December 2018 were enrolled. Among them， 87 patients who did not use green channel were selected as the control group， and the remaining 88 patients who turned to the green channel were categorized into the observation group. In the control group， intravenous thrombolytic therapy with Alteplase was provided after routine diagnosis and treatment， while in the observation group， intravenous thrombolysis of Alteplase was used after opening the green channel. The clinical data of the patients were retrospectively analyzed. The therapeutic effect， definite diagnosis time， transferring to specific department time， door to needle time （DNT） and intravenous thrombolysis rate were compared in the two groups. Results The therapeutic effect of the observation group was much better than that of the control group， the difference was statistically significant （P<0.05）. The time of definite diagnosis， transferring to a specific department， and DNT were significantly shorter in the observation group than those in the control group （P<0.05）. After admission for 1 and 3 h， the rates of intravenous thrombolysis in the observation group were higher than those in the control group. After admission for 4.5 h， the rate of intravenous thrombolysis was lower in the observation group than thant in the control group （P<0.05）. Conclusion For patients with acute ischemic stroke received intravenous thrombolysis of Alteplase， the opening of emergency green channel can markedly improve the therapeutic effect， shorten the time of definite diagnosis， transferring to a specific department， and DNT， and increase the intravenous thrombolysis rate 1 and 3 h after admission.

[Key words] Emergency green channel; Ischemic stroke; Alteplase; Intravenous thrombolysis

急性缺血性脑卒中是急诊常见疾病，其发病过程中脑组织缺血缺氧坏死会造成神经功能缺损，临床多表现为口眼歪斜、肢体偏瘫等，发病较急且病情进展较快，治疗不及时会造成脑细胞功能损伤，严重影响患者日后生活质量[1]，故及早疏通闭塞血管恢复局部血流对于缺血半暗带的恢复至关重要。临床中静脉溶栓是急性缺血性脑卒中的有效治疗手段，由于溶栓所涉及的诊断环节较多，需要各个科室协同合作，大大增加了有效时间内救治难度，中国目前总体静脉溶栓率不高，因各种条件限制很少患者可在60 min内得到有效治疗[2]，部分患者预后欠佳，因此建设和完善急诊卒中绿色通道十分重要，对提高抢救率及缩减患者初期抢救时长等方面非常关键，笔者在临床中發现开通急诊绿色通道可有效改善急性缺血性脑卒中患者溶栓效果，现回顾性分析本院开通绿色通道前后急性缺血性脑卒中患者溶栓效果，现报道如下。……