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目的探究基层医院急性脑梗死静脉溶栓绿色通道的构建及其效果。方法以2015年3月-2017年3月使用阿替普酶(rt-PA)静脉溶栓的45例急性脑梗死患者为观察组,观察组患者启动绿色通道管理流程,同时将rt-PA静脉溶栓地点前移到急诊重症监护室。以2013年1月-2015年2月在绿色通道管理流程实施前rt-PA静脉溶栓的45例急性脑梗死患者为对照组。观察与对比两组患者入院至开始静脉溶栓的时间(DNT)、DNT<60 min比例、治疗前后神经功能缺损评分及溶栓治疗显效率及总有效率。结果观察组较对照组相比DNT较短,DNT<60 min比例增高,差异具有统计学意义(P<0.05)。在溶栓后24 h与72 h,对照组与观察组患者神经功能缺损评分均显著下降,但观察组患者下降幅度明显较好,差异有统计学意义(P<0.05)。观察组较对照组相比显效率及总有效率均明显提高,差异有统计学意义(P<0.05)。结论在基层医院中构建急性脑梗死静脉溶栓的绿色通道,可有效缩短患者自就诊到接受溶栓治疗的时间,提高DNT<60 min比率,提高急性脑梗死溶栓治疗效果,值得临床推广。
Objective To investigate the construction of intravenous thrombolysis green channel in acute cerebral infarction in primary hospital and its effect. Methods From March 2015 to March 2017, 45 patients with acute cerebral infarction treated with intravenous alteplase (rt-PA) were enrolled in the observation group. Patients in the observation group started the green channel management procedure, and the rt-PA vein Thrombolysis site moved to emergency intensive care unit. Fifty-five patients with acute cerebral infarction who received rt-PA intravenous thrombolysis before the implementation of the green channel management process from January 2013 to February 2015 were selected as the control group. The time between admission and initiation of intravenous thrombolysis (DNT), the ratio of DNT <60 min, the score of neurological deficits before and after treatment, the effective rate of thrombolytic therapy and the total effective rate were observed and compared between the two groups. Results Compared with the control group, the DNT of observation group was shorter and the proportion of DNT <60 min was increased, the difference was statistically significant (P <0.05). The scores of neurological deficits in control group and observation group decreased significantly at 24 h and 72 h after thrombolysis, but the decrease in observation group was significantly better (P <0.05). Compared with the control group, the observation group showed significantly higher effective rate and total effective rate, the difference was statistically significant (P <0.05). Conclusions Establishing a green channel of venous thrombolysis in acute cerebral infarction in primary hospital can shorten the time from treatment to thrombolytic therapy, increase the ratio of DNT <60 min, and improve the thrombolytic effect of acute cerebral infarction. It is worthy of clinical promotion.