并联无缝链接救护模式在急性缺血性卒中的应用

目的 探讨"并联无缝链接"救护模式在优化急性缺血性卒中患者静脉溶栓流程中的应用效果.方法 回顾性连续纳入2012年5月至2013年9月符合本研究纳入排除标准的急性缺血性卒中患者91例为对照组接受串联救护模式,实验组回顾性连续纳入2014年2月至2016年7月经"并联无缝链接"救护模式收治的符合纳入排除标准的急性缺血性卒中患者274例.两组均于发病4.5小时就诊且接受rt-PA(重组组织型纤溶酶原激活剂)静脉溶栓治疗,比较两组患者从发病到静脉溶栓用药院内救治流程各环节所耗时间的变化.结果 就诊至影像学检查时间、影像学检查到静脉溶栓时间、就诊至静脉溶栓时间,实验组较对照组明显缩短(19.8±11)min比(60±18.6)min、(24.3±10.3)min比(68.0±28.5)min、(44.3±15.6)min比(114±26.5)min],组间差异均具有统计学意义(P<0.05).结论 "并联无缝链接"救护模式能够有效缩短DNT(door-to-needle),提高急性缺血性卒中患者rt-PA使用率.急性缺血性卒中院内静脉溶栓流程与国外先进模式相比,仍有较大改进空间;可借鉴德国柏林卒中救治成熟经验发展卒中移动单元,缩短DNT,提高静脉溶栓治疗效率.

Application and Evaluation of Parallel Seamless Connection Treatment Mode in Reducing the Door-to-needle Time of Patients with Acute Ischemic Stroke

Objective To Explore the effect of parallel seamless connection in reducing the door-to-needle time (DNT) of patients with acute ischemic stroke,which is the indicator of intravenous thrombolysis.Methods 91 patients with acute ischemic stroke admitted to our hospital between May 2012 and September 2013, were retrospectively enrolled as a control group to receive serial treatment.274 patients with acute ischemic stroke admitted to our hospital between February 2014 to July 2016, were retrospectively enrolled as an experimental group to receive parallel seamless connection treatment.The patients of both groups visited doctors within 4.5 hours after onset and received rt-PA intravenous thrombolysis therapy.The onset-to-needle time between the control group and the observation group was compared.Results In comparison with the control group, the time of door-to-imaging(19.8±11)min vs(60±18.6)min],imaging-to-needle(24.3±10.3)min vs(68.0±28.5)min],door to needle(44.3±15.6)min vs(114±26.5)min] of the experimental group was significantly shorter.Differences between the two groups were statistically significant (P<0.05).Conclusion The parallel seamless connection treatment mode can effectively shorten the door-to-needle time.The intravenous thrombolysis process among acute ischemic stroke patients has great room for improvement.We can draw valuable experiences from Berlin Germany to develop stroke emergency mobile unit to further shorten the DNT time and improve the rate of intravenous thrombolytic treatment.