[1]王英,吴娅,赵秋菊,等.院前预警对缩短急性缺血性卒中患者就诊到溶栓时间的影响[J].第三军医大学学报,2018,40(16):1523-1526.
 WANG Ying,WU Ya,ZHAO Qiuju,et al.Prenotification for thrombolysis before admission shortens door-to-needle time for patients with acute ischemic stroke[J].J Third Mil Med Univ,2018,40(16):1523-1526.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第16期
页码:
1523-1526
栏目:
临床医学
出版日期:
2018-08-30

文章信息/Info

Title:
Prenotification for thrombolysis before admission shortens door-to-needle time for patients with acute ischemic stroke
作者:
王英吴娅赵秋菊马雪李玮
陆军军医大学(第三军医大学)第三附属医院(野战外科研究所)神经内科
Author(s):
WANG Ying WU Ya ZHAO Qiuju MA Xue LI Wei

Department of Neurology, Third Affiliated Hospital, Institute of Surgery Research, Army Medical University (Third Military Medical University), Chongqing, 400042, China

关键词:
院前预警急性缺血性卒中卒中绿色通道静脉溶栓
Keywords:
prenotification acute ischemic stroke green channel of stroke intravenous thrombolysis
分类号:
R197.32; R459.7; R743.3
文献标志码:
A
摘要:

目的    观察院前预警对缩短急性缺血性卒中(acute ischemic stroke,AIS)患者就诊到溶栓时间以及对患者预后的影响。方法    对2016年6月至2017年6月经我院卒中绿色通道行静脉溶栓治疗的115例AIS患者临床资料进行回顾性分析,观察院前预警(n=40)和无院前预警经门、急诊就诊(n=75)进入卒中绿色通道患者就诊至接受重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓时间(door to needle time,DNT)的差异。同时观察2组患者发病至静脉溶栓时间(onset to needle time,ONT)、出院时的美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分、90 d良好神经功能预后(mRS评分0~2)率、90 d死亡率的差异。结果     院前预警组ONT略长于无院前预警组[(207.00±89.71)min vs (175.11±65.21) min,P=0.031];但DNT明显短于无院前预警组[(42.57±19.58)min vs (59.55±13.95)min,P<0.01];2组患者出院时NIHSS评分、90 d良好神经功能预后率、90 d死亡率比较差异无统计学意义(P>0.05)。进一步对各环节的时间节点分析结果显示,院前预警组患者入院-开始影像检查、获得影像结果-患者家属同意溶栓的时间明显短于无院前预警组(P<0.05,P<0.01);2组患者开始影像检查-影像检查结束时间、患者家属同意溶栓-开始溶栓时间比较差异无统计学意义(P>0.05)。结论    院前预警可明显缩短患者DNT。对于不具备溶栓条件的机构转诊可疑AIS患者时,应做到院前预警。

Abstract:

Objective    To evaluate the effect of prenotification before admission for thrombolysis in shortening the door-to-needle time (DNT) and on the outcomes of patients with acute ischemic stroke. MethodsThis retrospective analysis was conducted based on the data of 115 patients with acute ischemic stroke receiving intravenous thrombolytic treatment in our stroke center between June, 2016 and June, 2017. The difference in the DNT was analyzed between patients with prenotification for thrombolysis before admission (n=40) and those without prenotification (n=75). The onset-to-needle time (ONT), National Institutes of Health Stroke Scale (NHISS) score at discharge, the rate of good prognosis (mRS score 0 to 2) and the mortality rate at 90 days were also recorded and analyzed. ResultsThe ONT was slightly longer in the prenotification group than in the group without prenotificaiton (207.00±89.71 vs 175.11±65.21 min, P=0.031), but the DNT was significantly shorter in the prenotification group (42.57±19.58 vs 59.55±13.95 min, P<0.01). No significant difference was found between the 2 groups in NHISS scores at discharge, the rate of good prognosis or the mortality rate at 90 d (P>0.05). Compared with the patients without prenotificaiton, the patients with prenotification had significantly shorter door-to-imaging time (P<0.05) and the interval from the imaging report to consent by the patients’ relatives to thrombolysis (P<0.01). The duration of the imaging examination and the time from consent to thrombolysis to the start of thrombolysis therapy were similar between the 2 groups (P>0.05). Conclusion     Prenotification for thrombolysis before admission can shorten the DNT for patients with acute ischemic stroke. In the primary care centers where thrombolytic therapy is not accessible, prenotification of the hospital to which the patient is to be transferred can be essential.

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更新日期/Last Update: 2018-09-03