区域医疗系统的优化对急性缺血性脑卒中静脉溶栓品质的影响

徐冬娟 许芸芸 李鸿飞 张为强 韦潋滟 卢晓蓉

[摘要] 目的 探討区域医疗系统的优化对急性缺血性脑卒中（AIS）重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓品质的影响。 方法 收集2015年1—12月区域医疗系统的优化前所收治的2918例AIS患者为对照组，其中溶栓86例;收集2016年1月至2018年12月区域医疗系统的优化后所收治的10 879例AIS患者为试验组，溶栓552例。比较两组患者的静脉溶栓率。为了解质量改进持续优化效果，将试验组按时间等分为3个亚组，即优化后第1年、第2年、第3年，比较亚组间AIS患者静脉溶栓率及AIS溶栓患者入院至溶栓时间（DNT）及DNT≤60 min的比例。结果 13 797例AIS患者，区域医疗系统的优化前静脉溶栓率为2.9%，优化后溶栓率为5.1%，两组间差异有统计学意义（χ2=23.60，P<0.001）。优化后第1年、第2年、第3年进行比较，AIS患者静脉溶栓率从3.4%逐年提高到5.3%、6.6%，差异有统计学意义（χ2=37.49，P<0.001）;DNT均数从（71.15±26.45）min逐年下降至（60.94±24.65）min、（56.25±22.09）min，差异有统计学意义（F=14.71，P<0.001），AIS溶栓患者DNT≤60 min的比例由44.2%逐年提高到61.2%、65.3%，差异有统计学意义（χ2=14.80，P=0.001）。 结论 区域医疗系统的优化能提升急性缺血性脑卒中的静脉溶栓品质，即有效提高区域整体的静脉溶栓率、缩短DNT、提高DNT≤60 min的比例。

[关键词] 急性缺血性脑卒中;静脉溶栓;区域医疗系统;入院至溶栓时间

[中图分类号] R743.3          [文献标识码] B          [文章编号] 1673-9701（2021）31-0106-05

[Abstract] Objective To investigate the effect of optimization of regional medical system on the quality of intravenous thrombolysis by recombinant tissue plasminogen activator （rt-PA） in acute ischemic stroke （AIS）. Methods The 2918  cases of AIS who were admitted before the optimization of the regional medical system from January to December 2015 were collected as the control group， including 86 cases with thrombolysis. The 10 879 AIS patients after the optimization of the regional medical system from January 2016 to December 2018 were collected as the experimental group， including 552 cases with thrombolysis. The intravenous thrombolysis rate between the two groups was compared. In order to understand the continuous optimization effect of quality improvement， the experimental group was divided into three subgroups according to time， namely， the first year， the second year， and the third year after optimization. The intravenous thrombolysis rate， the door to needle time（DNT）， and the ratio of DNT≤60 min among the subgroups were compared. Results In 13 797 AIS patients， the intravenous thrombolysis rate before optimization of the regional medical system was 2.9%， and the thrombolysis rate after optimization was 5.1%. The difference was statistically significant between the two groups（χ2=23.60， P<0.001）. Comparing the first year， the second year， and the third year afte optimization， the intravenous thrombolysis rate of AIS patients increased from 3.4% to 5.3% and 6.6% year by year， the difference was statistically significant （χ2=37.49， P<0.001）; the mean DNT decreased from （71.15±26.45） min to （60.94±24.65） min and （56.25±22.09） min，the difference was statistically significant（F=14.71， P<0.001）; the proportion of AIS thrombolytic patients with DNT≤60 min increased from 44.2% to 61.2% and 65.3%，the difference was statistically significant（χ2=14.80， P=0.001）. Conclusion The optimization of the regional medical system can improve the quality of intravenous thrombolysis in acute ischemic stroke， effectively increase the overall intravenous thrombolysis rate， shorten DNT， and increase the ratio of DNT≤60 min of the region.

[Key words] Acute ischemic stroke; Intravenous thrombolysis; Regional medical system; Time from admission to thrombolysis

快速血管再灌注治疗是急性缺血性脑卒中（Acute ischemic stroke，AIS）救治的最有效方案，主要包括静脉注入重组组织型纤溶酶原激活剂（Recombinant tissue plasminogen activator，rt-PA）和桥接动脉取栓术，但两者均有严格的时间窗限制，由于种种原因引起的院前、院内延误，AIS患者容易失去再灌注治疗时机。……