| Objective: Intravenous thrombolysis is the most effective method for the treatment of acute ischemic stroke(AIS)at present,and its effect is time-dependent.The purpose of this study was to explore the optimization and improvement of emergency green channel,the time(door to need time,DNT)from admission to thrombolysis with rt-PA in patients with AIS,and the impact on the prognosis of patients.Methods: From January 2018 to January 2020,82 patients with acute ischemic stroke who used RT PA intravenous thrombolysis were divided into prolonged group(DNT > 60 min,n = 42)and non prolonged group(DNT ≤ 60 min,n = 40)according to different DNT.By comparing the clinical data of the two groups,the influencing factors of DNT prolongation in AIS patients were analyzed.The patients after the optimization of emergency green channel were set as the optimization group(n = 45)(2018-12-2020-01),and the patients before the optimization were set as the control group(n = 37)(2018-01-2018-11).Optimize and improve the time from the onset to the reception,the arrival time of consultation,the time to complete blood collection,the time to receive blood samples in the laboratory,the time to report the test results,the time from the reception to the completion of CT,the time from the completion of CT to the signature of the conversation,the time from the signature to the start of intravenous thrombolysis,DNT.The NIHSS and Mrs scores of the two groups were compared at 24 hours,7 days and 90 days after thrombolysis.Results: The 82 patients,47 were male,accounting for 57.31%,35 were female,accounting for 42.69%.There was no significant difference between the two groups in terms of gender;the age of the non extended group was smaller than that of the extended group.In terms of means of transportation,the median of pre hospital transit time of bus is the longest,and that of ambulance is the shortest;in terms of emergency triage,there is no statistical difference between the two groups.Comparing the blood pressure and blood glucose of the two groups,the prolongation group was worse;comparing the thrombolysis decision-making time,the prolongation group was significantly longer than the non prolongation group;comparing the NIHSS score atadmission,the non prolongation group was higher than the prolongation group.There were significant statistical differences between the two groups in the factors of emergency blood pressure reduction,glucose reduction and green channel.The results of logistic regression analysis showed that emergency blood pressure reduction,pre hospital notice,emergency blood pressure reduction,green channel,talk time,elevator waiting time,etc.could affect DNT.After optimizing the emergency green channel,DNT was shortened from87.97 min in the control group to 57.27 min in the optimization group,the difference was statistically significant(P The difference between the two groups was statistically significant(P < 0.05)There was no significant difference between the two groups(P >0.05).Conclusions: The risk of DNT delay in hospital is lower in AIS patients who are relatively young,with atrial fibrillation,blood pressure and blood glucose level up to standard,who have a short time from onset to admission and decision-making.Through the optimization and improvement of the emergency green channel,the quality management of the controllable factors affecting the intravenous thrombolysis DNT of the patients with acute ischemic stroke can significantly shorten the DNT,reduce the NIHSS score and MRS score of the patients 24 hours after thrombolysis,7days after the onset,90 days after the onset,so as to improve the prognosis of the patients with acute ischemic stroke. |
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