临床药师在急性缺血性脑卒中患者溶栓治疗中的实践研究

目的：探究临床药师在降低急性缺血性脑卒中患者就诊至开始溶栓时间（door-to-needle time，DNT）中的作用。方法：对保定市第一中心医院神经内一科2019年1月至2020年2月的急性缺血性脑卒中静脉溶栓患者进行单中心回顾性队列研究，根据药师是否参加治疗分为实验组及对照组。研究的主要结局指标为实验组与对照组患者DNT的差异比较；次要结局指标为实验组与对照组DNT<45 min、DNT<60 min的占比差异及药物剂量、NIHSS评分变化值、住院时长等比较。结果：研究共纳入59名患者，实验组29名，对照组30名。其中实验组与对照组的平均DNT分别为（50±14.6） min和（66±25.5） min （P<0.01），DNT<60 min的患者比例分别为82.75%，43.33%（P<0.01），NIHSS评分变化值（溶栓前-溶栓后）中位数分别为0（0~33）、0（-5~2）（P<0.05）；DNT<45 min的患者比例、药物剂量、住院天数差异无统计学意义。结论：临床药师参与急性缺血性脑卒中患者溶栓治疗有助于降低DNT。

Clinical pharmacists impact on thrombolysis in acute ischemic stroke

OBJECTIVE To explore the role of clinical pharmacists in reducing the time from presentation to initiation of thrombolysis (DNT) in patients with acute ischemic stroke..METHODS A single-center retrospective cohort study was conducted on patients with acute ischemic stroke who received intravenous thrombolysis from January 2019 to February 2020 in the Department of Neurology I of Baoding First Central Hospital.They were divided into the experimental group and the control group according to whether the pharmacists participated in the treatment.The primary outcome measure of the study was the difference in DNT between the experimental group and the control group;the secondary outcome measures were the difference in the proportion of DNT<45 min and DNT<60 min and the comparison of drug dose,NIHSS score change value,and length of hospital stay between the experimental group and the control group.RESULTS A total of 59 patients were included in the study,including 29 patients in the experimental group and 30 patients in the control group.Among them,the mean DNT of the experimental group and the control group were (50±14.6) min and (66±25.5) min,respectively (P<0.01),the proportion of patients with DNT<60 min was 82.75% and 43.33%,respectively (P<0.01),and the median NIHSS score change values (before thrombolysis-after thrombolysis) were 0 (0-33) and 0 (-5-2),respectively (P<0.05);there was no significant difference in the proportion of patients with DNT<45 min,drug dose,and length of hospital stay.CONCLUSION Clinical pharmacists involvement in thrombolytic therapy in patients with acute ischemic stroke may have a beneficial effect on decrease of DNT.