【摘要】 目的探讨控制院内延迟时间(DNT)对缺血性卒中静脉溶栓效果的影响。方法收集台州市9家基层医院168例4.5h内接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的急性缺血性卒中患者临床资料,统计DNT和各控制因素的平均时间;采用滚动平均时间追踪法,以2014年10月为界对可控因素进行质量管理,分析质量管理前后基线数据、DNT相关因素,并作疗效评估。结果质量管理后,DNT从(79.50±26.97)min缩短为(68.64±24.30)min(P<0.05),DNT≤60min的比例从35.29%上升至40.91%,90d改良Rankin量表(mR S)<2分的比例从48.0%上升至60.6%。"到院至谈话""到院至病房""完成CT检查至用药"等时间均明显缩短(均P<0.05)。结论对影响静脉溶栓DNT的可控因素进行质量管理,能明显缩短DNT、改善卒中患者预后,可在基层医院实施并推广。更多还原

【Abstract】 Objective To assess the effect of shortening hospital delay time on intravenous thrombolysis in patients with ischemic stroke. M ethods One hundred and sixty eight patients with acute ischemic stroke receiving rt-PA intravenous thrombolytic treatment within 4.5 hours of onset in 9 secondary hospitals in Taizhou city were collected in this study. The average door-to-needle time(DNT) and the mean time of controlling factors were documented. The independent factors associated with DNT and the prognosis of patients were compared before and after quality management program(October 2014) using rolling time tracking method. Results After quality management, the DNT was reduced from(79.50±26.97) min to(68.64±24.30) min(P<0.05), the ratio of DNT≤60min increased from 35.29% to 40.91%, and the ratio of the 90 days mR S<2 increased from 48.0% to60.6%. The time from admission to reaching consensus, from admission to arriving ward, and from completing CT examination to medication were significantly shortened(P<0.05). Conclusion The quality management can shorten the hospital delay time and improve the prognosis of acute ischemic stroke patients receiving intravenous thrombolytic therapy.更多还原