急诊一体化运转模式在rt-PA治疗急性期脑梗死中的意义

目的:探讨急诊一体化运转模式在急性期脑梗死进行溶栓治疗的意义。方法:对比实施急诊一体化运转模式前后1年中脑梗死患者进行溶栓治疗的比例和开始溶栓时间;对比发病3 h、发病6 h但3 h行rt-PA溶栓和发病6 h脑梗死患者行内科保守治疗的三组患者治疗前、治疗后1 d、7 d、21 d的神经功能情况。结果:实施一体化前后一年中脑梗死患者进行溶栓治疗的比例分别为20.9%和38.3%,开始溶栓时间分别为(4.7±1.5)h和(3.8±1.6)h;发病3 h、发病3 h但6 h进行rt-PA溶栓治疗前和发病6 h保守治疗前三组的NIHSS评分无明显差异,治疗1d后NIHSS评分分别为(7.2±5.2)分、(8.2±5.5)分和(12.9±4.6)分,7 d后分别为(4.9±5.9)分、(6.8±6.3)分和(9.7±5.5)分,21 d后分别为(4.0±4.8)分、(5.7±4.6)分、(8.7±4.0)分,各组间均有明显差异(P0.05)。结论:急救一体化运转模式能有效缩短脑梗死诊断时间,有助于患者得到及时的溶栓治疗,提高脑梗死患者的神经功能恢复程度。

The Significance of Integrated Emergency Operation Mode in the rt-PA Treatment of Aacute Cerebral Infarction

Objective：To explore the significance of the integrated emergency operation mode in the acute phase of cerebral infarction thrombolysis. Method： Compared with the proportion of patients with thrombolytic therapy and the time start thrombolysis between one year before and after the implement of the integrated emergency operation mode. Contrasted neurological conditions of patients before and after treatment 1 d, 7 d, 21 d of the three groups which onset 〈 3 h, onset 〈 6 h but 〉 3 h for rt-PA thrombolysis and morbidity 〉 6 h infarction patients after conservative treatment. Results： The thrombolytic therapy in patients with cerebral infarction rates of year before and after the implementation of integrated were 20.9% and 38.3%, thrombolytic time were （4.7±1.5）h and （3.8±1.6） h. NIHSS score of the three groups before treatment had no significant difference, NIHSS score after treatment ld were 7.2±5.2,8.2±5.5 and 12.9±4.6,NIHSS score after treatment 7 d were 4.9±5.9,6.9±6.3,9.7±5.5,respectively, NIHSS score after treatment 21 d were 4.0±4.8,5.7±4.6,8.7±4.0, difference between the groups was statistically signifieant（P 〈 0.05）. Conclusion： The integrated emergency operation mode can effectively shorten the integration time of diagnosis of cerebral infarction, can improve recovery degree of neurological function in patients with cerebral infarction because of receiving timely thrombolytic therapy.