急性缺血性脑卒中院前及院内急救时间节点分布研究

目的：总结急性缺血性脑卒中患者在院前及院内急诊救治现状,探讨影响其在院前、院内急诊救治延迟和治疗效果的因素,以改善预后。方法：回顾性分析广东省梅州市人民医院2019年1月至2020年8月期间急诊收治的64例急性缺血性脑卒中患者的临床资料,根据来院方式分为院外出诊接回10例（院前急救组）,自行来院接诊54例（非院前急救组）,统计院前及院内急诊救治时间,包括头颅CT扫描时间、获取影像学报告时间、溶栓治疗时间节点,对院内外救治关键环节耗费时间进行统计分析。结果：与美国国立神经病与卒中研究院（NINDS）规定的脑卒中救治标准流程和标准时间相比,非院前急救组的院内诊治各关键环节耗时明显延迟性（P<0.05）;非院前急救组较救治与院内救治关键环节耗时在CT报告获取时间、静脉溶栓时间与明显延长（P<0.05）。结论：在急性缺血性脑卒中患者的急救过程中,院内诊治延迟严重,导致确诊对患者治疗延迟;在院前对患者进行有效的急救能够缩短院内急救时间,改善急性缺血性脑卒中患者的预后。     

院前院内协同救治平台在急性缺血性脑卒中静脉溶栓患者中的应用

目的 探讨院前院内协同救治平台在急性缺血性脑卒中静脉溶栓中的应用效果。方法 选取2019年1月1日~2021年6月31日在我院接受静脉溶栓的急性缺血性脑卒中患者177例。根据我院应用院前院内协同救治平台进行管理干预前后为节点,进行分组。将2020年7月1日应用院前院内协同救治平台前收治的72位急性缺血性脑卒中患者为对照组,应用院前院内协同救治平台前收治的85位急性缺血性脑卒中患者为平台干预组。平台干预组利用院前院内协同救治平台对救治流程各个环节时间点进行实时追踪记录；对照组使用院内自制救治流程记录表对患者的各项时间资料进行手工记录。比较两组静脉溶栓流程中各环节所需时间及医患满意度情况。结果 平台干预组相对于对照组到院至CT时间(door-to-imaging time,DIT)和到院至静脉溶栓时间(door-to-needle time,DNT)明显缩短,平台干预组的医护人员的满意度明显高于对照组,差异均有统计学意义(P<0.05)。结论：对急性缺血性脑卒中救治流程实施信息化管理可以提高静脉溶栓的救治时效性和医护的满意度。     

急性缺血性脑卒中院内急诊救治时间调查与分析

目的：调查急性缺血性脑卒中院内急诊救治各流程所用时间,分析影响因素。方法通过回顾性分析某三甲医院急诊科在2011年1月至2014年12月收治的115例急性缺血性脑卒中患者静脉溶栓治疗情况,统计急诊救治各流程所用的时间。结果该院急性缺血性脑卒中急诊救治流程与国际指南推荐的时长存在明显延误。结论缩短救治时间对急性缺血性脑卒中患者的抢救有较大的影响,优化急诊救治流程对急性缺血性脑卒中患者的抢救意义重大。     

基于业务流程再造理论的急性缺血性脑卒中病人静脉溶栓流程的现况分析

[目的]基于业务流程再造理论分析急性缺血性脑卒中病人静脉溶栓流程的现状及其院内延误的影响因素。[方法]以现场追踪调查法对47例急性缺血性脑卒中静脉溶栓病人进行调查,并绘制因果分析图分析院内延误关键环节的影响因素。[结果]病人入院至CT出报告、入院至检验结果出报告、入院至溶栓用药中位时间分别为47.0min,92.0min,112.5min,均高于国际标准,且入院至溶栓用药时间≤60min的百分比仅为5%;因果分析图显示院内延误的影响因素为医院急救组织管理体系缺失、脑卒中信息化平台未完善、专业业务培训不足和质量监控有待改进等。[结论]构建急救组织管理体系、研发急诊脑卒中信息化共享平台、加强专业业务培训、实施持续性质量改进计划等措施是缩短院内延误时间的关键因素。     

基于业务流程再造理论的急性缺血性脑卒中病人静脉溶栓流程的现况分析

[目的]基于业务流程再造理论分析急性缺血性脑卒中病人静脉溶栓流程的现状及其院内延误的影响因素。[方法]以现场追踪调查法对47例急性缺血性脑卒中静脉溶栓病人进行调查,并绘制因果分析图分析院内延误关键环节的影响因素。[结果]病人入院至CT出报告、入院至检验结果出报告、入院至溶栓用药中位时间分别为47.0min,92.0min,112.5min,均高于国际标准,且入院至溶栓用药时间≤60min的百分比仅为5%;因果分析图显示院内延误的影响因素为医院急救组织管理体系缺失、脑卒中信息化平台未完善、专业业务培训不足和质量监控有待改进等。[结论]构建急救组织管理体系、研发急诊脑卒中信息化共享平台、加强专业业务培训、实施持续性质量改进计划等措施是缩短院内延误时间的关键因素。     

多学科协作下的流程管理在急性缺血性脑卒中溶栓治疗中的应用

目的 探讨多学科协作下的流程管理在急性缺血性脑卒中溶栓治疗中的应用。方法 对2016年7月至2018年12月急性缺血性脑卒中进行溶栓的140例患者作为观察组,实施多学科协作下的急救溶栓流程管理,回顾性调查2015年1月至2016年6月按急诊科常规急救流程溶栓的18例患者作为对照组,比较2组的救治效果。结果 观察组的CT 完成时间、溶栓DNT、溶栓率分别为（23.85±6.85）min、（ 43.15±13.25）min、8.12%,对照组分别为（39.83±12.28）min、（72.48±25.38））min、1.89%。2组比较观察组明显优于对照组,差异有统计学意义（t=8.37、8.05,χ2=38.76,均P＜0.01）。结论 多学科协作下的急性缺血性脑卒中静脉溶栓急救流程重建,有利于提高团队的工作效率,减少静脉溶栓的院内延迟,缩短溶栓患者的用药时间,提高静脉溶栓率,值得临床推广和应用。     

急性缺血性脑卒中患者静脉溶栓流程优化的研究进展

急性脑卒中溶栓院内延迟是造成在时间窗内的患者得不到溶栓救治的主要原因,故优化急诊院内救治流程刻不容缓,本文对国内外急诊急性缺血性脑卒中静脉溶栓流程优化研究进行综述,旨在找出优化再造的机制和关键环节,为临床实践提供循证依据。     

北京市急性缺血性脑血管病患者院前延迟时间分布及影响因素分析

目的 调查现阶段北京市急性脑卒中患者的院前延迟时间分布情况以及主要的影响因素.方法 本文主要通过收集北京市现阶段急性脑卒中患者的就诊流程的资料,详细记录院前延迟时间段以及患者的一般信息,通过统计学方法试分析影响院前延迟的主要因素.结果 自2005-10～2006-10,连续收集北京市15家三甲医院698例急性缺血性脑血管病患者,发病年龄31～89岁,平均56.72±12.96岁;院前延迟时间范围分布为0.83～19.17 h,中位数为6.61 h;其中,使用EMS(急救系统)的院前延迟中位时间为4.65 h,未使用EMS的院前延迟中位时间为6.95 h;3 h内就诊率为16.4%,6 h内就诊率为34.1%;多元逻辑回归分析出影响因素主要有3个,分别是发病时间、基层医院延迟以及发病后的疾病严重程度.结论 使用EMS可以缩短院前延迟时间;应当加强公众脑血管病知识教育,并宣传EMS的作用,同时加强医院与急救系统的密切合作,说明建设急性脑卒中救治绿色通道的必要性.     

急性缺血性脑卒中病人急诊静脉溶栓干预措施及效果评价

[目的]探讨急性缺血性脑卒中病人急诊静脉溶栓干预措施及效果,为脑卒中防治策略提供依据。[方法]选择2014年4月—2016年4月我院收治的急性缺血性脑卒中急诊静脉溶栓病人63例为研究对象。回顾分析病人从就诊至收治卒中单元5个环节时间,包括就诊至CT检查时间(DIT)、就诊至CT报告时间(T1)、CT报告至静脉溶栓时间(INT)、就诊至静脉溶栓时间(DNT)、就诊至入卒中单元时间(T2);统计静脉溶栓前、入院第7天美国国立卫生研究院卒中量表(NIHSS)评分及四肢肌力情况。[结果]63例急性缺血性脑卒中急诊静脉溶栓病人DIT(18.84min±14.32min),T1(32.54min±16.20min)比NINDS国际标准建议时间短,而INT(44.32min±24.67min)、DNT(72.52min±32.47min)、T2(480.00min±480.92min)比NINDS国际标准建议时间长。急性缺血性脑卒中病人溶栓前NIHSS评分(9.66分±6.20分)与入院第7天NIHSS评分(5.00分±5.58分)比较差异有统计学意义(P0.05)。急性缺血性脑卒中急诊静脉溶栓病人入院第7天神经功能治愈15例,显效25例,有效7例,病人肌力≤3级7例。[结论]对急性缺血性脑卒中病人实施急诊静脉溶栓干预措施缩短了院内抢救时间,提高了急性缺血性脑卒中静脉溶栓效率及治疗效果,四肢肌力得到明显改善。     

急性脑卒中院前急救服务的临床应用价值

目的分析院前急救服务在急性缺血血性脑卒中患者救治中的临床应用价值。方法选取2019年8月至2021年8月我院收治的68例急性缺血性脑卒中患者,依据急救方式不同分为对照组和观察组各34例。对照组由家属自行送达医院,之后依据我国标准化脑卒中急救流程开展院内急救措施,观察组通过院前急救服务到达医院后依据我国标准化脑卒中急救流程开展院内救治。比较两组救治时间、格拉斯哥昏迷(GCS)评分及格拉斯哥预后(GOS)评分、神经功能、溶栓情况、并发症。结果观察组发病至CT检查完成、发病至溶栓及住院时间均短于对照组,差异有统计学意义(P<0.05);观察组出院时GCS评分、GOS评分均高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05);观察组溶栓率高于对照组,并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论对急性缺血性脑卒中患者进行合理的院前急救服务,可缩短发病至来院CT检查及溶栓时间,减少并发症发生,明显改善患者生活质量,临床应用效果显著。     

Recognition of Stroke by EMS is Associated with Improvement in Emergency Department Quality Measures

Objective: Hospital arrival via Emergency Medical Services (EMS) and EMS prenotification are associated with faster evaluation and treatment of stroke. We sought to determine the impact of diagnostic accuracy by prehospital providers on emergency department quality measures. Methods: A retrospective study was performed of patients presenting via EMS between September 2009 and December 2012 with a discharge diagnosis of transient ischemic attack (TIA), ischemic stroke (IS), or intracerebral hemorrhage (ICH). Hospital and EMS databases were used to determine EMS impression, prehospital and in-hospital time intervals, EMS prenotification, NIH stroke scale (NIHSS), symptom duration, and thrombolysis rate. Results: 399 cases were identified: 14.5% TIA, 67.2% IS, and 18.3% ICH. EMS providers correctly recognized 57.6% of cases. Compared to cases missed by EMS, correctly recognized cases had longer median on-scene time (17 vs. 15 min, p = 0.01) but shorter transport times (12 vs. 15 min, p = 0.001). Cases correctly recognized by EMS were associated with shorter door-to-physician time (4 vs. 11 min, p < 0.001) and shorter door-to-CT time (23 vs. 48 min, p < 0.001). These findings were independent of age, NIHSS, symptom duration, and EMS prenotification. Patients with ischemic stroke correctly recognized by EMS were more likely to receive thrombolytic therapy, independent of age, NIHSS, symptom duration both with and without prenotification. Conclusion: Recognition of stroke by EMS providers was independently associated with faster door-to-physician time, faster door-to-CT time, and greater odds of receiving thrombolysis. Quality initiatives to improve EMS recognition of stroke have the potential to improve hospital-based quality of stroke care.     

河北省急性心肌梗死患者使用急诊医疗服务系统现状分析及对治疗和预后影响

目的:调查河北省急性心肌梗死（acute myocardial infarction, AMI）患者使用急诊医疗服务系统（emergency medical service, EMS）现状及其对患者急性期治疗和近、远期预后的影响。方法:收集河北省主要三级及部分具有代表性的二级医院在2016年1至12月期间住院的AMI患...     

Time Delays in Accessing Stroke Care in the Emergency Department

OBJECTIVE: To delineate components of delay within the hospital ED for patients presenting with symptoms of stroke. METHODS: A prospective registry of patients presenting to the ED with signs or symptoms of stroke was established at a university hospital from July 1995 to March 1996. The ED arrival time, time to being seen by an emergency physician (EP), time to CT scan, and time to neurology consultation were obtained by medical record review. RESULTS: The median delay (interquartile range) from ED arrival to being seen by an EP for the 170 eligible subjects was 0.42 (0.20-0.75) hours. The median delay to CT scan was 1.88 hours (1.25-2.67) and the median delay to neurology consultation was 2.42 hours (1.50-3.48). Age, race, sex, and hospital discharge diagnosis had little influence on delay. Subjects arriving by emergency medical services (EMS) had a significantly shorter time to being seen by an EP (0.33 vs 0.50 hours) when compared with those who arrived by other means. Time to CT scan was shorter by 0.5 hours for patients arriving by EMS as well. These differences persisted when stratified by out-of-hospital delay times. CONCLUSIONS: These data suggest that arriving by EMS is associated with shorter times to being seen by an EP and receiving a CT scan. The influence of EMS on delays associated with rapid medical care of stroke patients reaches beyond the out-of-hospital transport phase.     

Evaluating Target: Stroke guideline implementation on assessment and treatment times for patients with suspected stroke

ObjectivesImmediate ischemic stroke treatment improves outcomes and early alteplase administration is recommended for patients within window. We implemented stroke guidelines through a neuro-resuscitation initiative (NRI) and hypothesized that the intervention would decrease times to assessment and treatment.MethodsWe analyzed quality assurance data for EMS and triage patients arriving to our academic emergency department with suspected ischemic stroke to compare outcomes 12 months before to 6 months after initiative implementation at an academic certified primary stroke center in the U.S. Southwest. We examined four time-based outcomes: neurology at bedside, CT head without contrast, CT head angiogram, and alteplase administration. We summarized times with median and IQR values and compared pre and post times to event (in minutes) with Wilcoxon rank sum tests and Kaplan-Meier survival curves.ResultsWe identified 203 EMS (83 pre, 120 post) and 66 (11 pre, 55 post) triage Stroke Alert patients. We observed decreased times for all outcomes in both the EMS and triage samples; however, only those in the EMS sample were significant. In the EMS sample, neurology at bedside median times decreased from 20 min to 2 min (p < 0.001); median minutes to CT head without contrast decreased from 16 min to 9 min (p < 0.001); median minutes to CT head angiogram decreased from 71 min to 21 min (p = 0.007); and, median minutes to alteplase decreased from 72 min to 49.5 min (p = 0.04).ConclusionsAn academic ED led stroke care initiative streamlined evaluation and care with significantly shortened times to all four events.     

Lack of t-PA use for acute ischemic stroke in a community hospital: high incidence of exclusion criteria

Thrombolytic therapy with t-PA for acute ischemic stroke may provide benefit in long-term outcome. This retrospective study was undertaken to evaluate appropriateness of the National Institute of Neurological Disorders and Stroke (NINDS) protocol in the emergency department (ED). All patients with appropriate International Classification of Diseases, 9th revision (ICD-9) codes indicating stroke who presented to our 387-bed trauma-I community hospital during 1997 were included in the study. Of the nearly 35,000 patients screened, 201 patients satisfied our inclusion criteria. Mean age was 73.5 +/- 13.3 years. Men were evaluated and transported to computed tomography more rapidly and older patients more slowly. Nonwhites were more likely to arrive via emergency medical services (EMS). Average time from EMS arrival at scene to ED arrival was 22.7 minutes, and from ED arrival to triage was 8.4 minutes. The most common reason for exclusion from t-PA administration was delayed presentation (n = 188); this is the most serious barrier to use of t-PA for acute ischemic stroke. Extensive public education may combat this.     

卒中溶栓因流程因素导致院内延迟的研究进展

静脉溶栓是目前治疗急性缺血性脑卒中的有效手段,但受到时间窗限制?院内延迟可能会使部分到院时还在时间窗内的患者失去溶栓治疗的时机?本文通过对患者到院至静脉溶栓流程图进行分析,并查阅相关文献对缺血性脑卒中溶栓患者院内延迟的现状和因诊疗流程相关因素导致院内延迟的原因进行综述。主要目的为缩短院内延迟时间提供参考?     

医护人员对急性缺血性卒中院内救治静脉溶栓流程优化的质性研究

目的探讨急性缺血性卒中静脉溶栓流程中可优化环节,为救治流程进一步优化提供依据。方法 2016年5-6月,采用目的抽样方法选取上海市某三级甲等医院12名参与急性缺血性卒中院内救治医务人员为研究对象,运用半结构式深入访谈法对其进行访谈,通过笔记及录音采集数据,应用Colaizzi内容分析法进行资料分析。结果医护人员对急性缺血性卒中院内救治静脉溶栓流程的体验包括5个主题:(1)目前救治流程基本合理;(2)对卒中急救护士配置的需求;(3)对信息化平台支持的需求;(4)患者和家属医疗决策时间延迟;(5)对多学科合作密切性加强的需求。结论有必要将溶栓地点前移至CT室并配置卒中急救护士岗位,加快建设急性缺血性卒中救治信息平台,开展院内多元化病情告知方式,加强多学科合作密切性,进一步缩短急性缺血性卒中院内救治时间。     

“一键启动”流程优化在缩短急性缺血性脑卒中患者静脉溶栓时间中的应用

目的 探讨“一键启动”流程优化在缩短急性缺血性脑卒中患者静脉溶栓时间中的应用效果。方法 选择2020年1-12月笔者所在医院收治的急性缺血性脑卒中静脉溶栓患者86例为研究对象,其中2020年1-6月入院进行静脉溶栓的41例为对照组,2020年7-12月入院进行静脉溶栓的45例为观察组。对照组采用常规抢救流程,观察组采用“一键启动”流程优化进行干预。比较2组入院至见到神经内科医生的时间（door to physician,DTP）、入院至实验室检查出报告时间（door to laboratory,DTL）、入院至溶栓用药时间（door to needle time,DNT）、入院至完成CT检查的时间（door to imaging,DTI）、美国国立卫生研究院卒中量表（national institute of health stroke scale,NIHSS）评分与改良RANKIN量表（modified Rankin scale,MRS）评分。结果 观察组DTP、DTL、DTI、DNT均明显短于对照组（Z=-8.506,P<0.001;Z=-6.750,P<0.001;Z...