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精细化时间管理联合组织化卒中管理对急性缺血性脑卒中患者静脉溶栓疗效的影响
高君武,刘海洋,陈治国,檀立端,关亚男
0
(承德市中心医院急救中心)
摘要:
目的 探讨精细化时间管理联合组织化卒中管理对急性缺血性脑卒中患者静脉溶栓疗效的影响。 方法 回顾性分析2013年4月~2018年4月我院应用重组组织型纤溶酶原激活剂溶栓的500例急性缺血性脑卒中患者(AIS)的临床资料,以2015年10月为分界点,我院在此分界点前后脑卒中静脉溶栓实施两种管理模式,分别为组织化卒中管理组(对照组)及精细化时间管理联合组织化卒中管理组(观察组),其中对照组219例,观察组281例。分别比较两组患者静脉溶栓24h疗效、溶栓流程各环节时间及其达标率、临床结局参数、溶栓治疗后评价静脉溶栓24h、出院时及随访出院6个月Barthel指数评分。结果 观察组患者静脉溶栓24 h疗效较对照组明显提高(P<0.05);观察组各环节时间均明显少于对照组((P<0.05);观察组各时间达标率均明显高于对照组(P<0.05);观察组患者的住院天数、住院费用、出血转化率、6个月死亡率及6个月再入院率明显少于对照组(P<0.05); 观察组患者溶栓24h、出院及出院6个月的无功能障碍患者占比明显高于对照组(P<0.05);观察组患者溶栓24h中、重度功能障碍患者占比明显低于对照组(P<0.05)。结论 实施精细化时间管理联合组织化卒中管理可显著提高急性缺血性脑卒中患者静脉溶栓疗效。
关键词:  急性缺血性脑卒中  溶栓治疗  时间管理  组织化卒中管理
DOI:
基金项目:承德市科技支撑计划项目(201706A030)
The effects of refined time management combined with organized stroke management on intravenous thrombolysis in patients with acute ischemic stroke
GAO Junwu,LIU Haiyang,CHEN Zhiguo,TAN Liduan,GUAN Yanan
(Emergency Center, Chengde Central Hospital)
Abstract:
Objective To explore the effects of refined time management combined with organized stroke management on intravenous thrombolysis in patients with acute ischemic stroke. Methods 500 patients with acute ischemic stroke were treated with recombinant tissue plasminogen activator thrombolytic therapy from April 2013 to April 2018. With October 2015 as the demarcation point, our hospital implemented two management modes of intravenous thrombolysis for stroke including organized stroke management group (control group, 219 cases) and refined time management combined with combined stroke management group (experimental group, 281 cases). The curative effect of 24 hours of intravenous thrombolysis, the time of each link of thrombolysis process and the rate of reaching the standard, the evaluation of 24 hours of intravenous thrombolysis after thrombolysis, the Barthel index score at discharge and 6 months of followup were compared between the two groups. The Barthel index score and other clinical outcome parameters were compared. Results The therapeutic effect of 24 hours intravenous thrombolysis in the observation group was significantly higher than that in the control group (P<0.05). The rate of reaching the standard in each time in the observation group was significantly higher than that in the control group (P<0.05). In the observation group, the hospitalization days, hospitalization expenses, conversion rate of bleeding, 6month mortality rate and 6month readmission rate were significantly lower than those in the control group (P<005). The proportion of patients without dysfunction in the observation group after thrombolysis for 24 hours, discharge and discharge for 6 months was significantly higher than that in the control group (P<0.05). The proportion of patients with moderate and severe dysfunction after 24 hours thrombolysis in the observation group was significantly lower than that in the control group (P<0.05). Conclusion Implementation of refined time management combined with organized stroke management can significantly improve the efficacy of intravenous thrombolysis in patients with acute ischemic stroke
Key words:  Acute ischemic stroke  Thrombolysis  Time management  Organized stroke management

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