| Part Ⅰ Effect of Referral in Primary Hospital on Intravenous Thrombolysis of Acute Ischemic Stroke Objective: To explore the effect of referral in primary hospitals on intravenous thrombolytic therapy for acute ischemic stroke.Methods: 413 cases of intravenous thrombolysis in our hospital from January 2011 to October 2018 were enrolled.All patients met the requirements of intravenous thrombolysis in the Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China in 2010.Finally 374 cases were eventually enrolled with the exclusion of hospital-onset and thrombolysis with urokinase.They were divided into referral group and non-referral group according to referral status.All patients’ 3-month good prognosis(defined as MRS score 0-2)was collected.Results:1.The improved procedure significantly shortened the door-to-needle time(DNT),and the difference was statistically significant(P values were less than 0.001).2.The median time from onset to treatment in referral group was significantly higher than that in non-referral group for nearly one hour(151 min vs.96 min),and the difference was statistically significant.Although the time from onset to treatment in referral group was significantly shorter than that in non-referral group(52 min vs.77 min),the time from onset to treatment in referral group was significantly shorter than that in nonreferral group(151 min vs.96 min).The median time was significantly higher in the non-referral group(203 min vs 183 min)and the difference was statistically significant.Conclusion: For patients with ischemic stroke,the earlier intravenous thrombolysis is used,the higher probability of achieving good clinical prognosis.It is suggested that primary hospitals have better actively carry out intravenous thrombolysis treatment.Patients with conditional intravenous thrombolysis should receive thrombolysis in the local area.Part II Improvement of Intravenous Thrombolysis Process and Analysis of Clinical Prognosis in Patients with Acute Ischemic StrokeObjective: To explore the improvement process of intravenous thrombolysis for acute ischemic stroke through self-experience,which is suitable for primary hospitals,and analyses its clinical prognosis.Methods: 413 cases of intravenous thrombolysis in our hospital from January 2011 to October 218 were enrolled.All patients met the requirements of intravenous thrombolysis in the Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China in 2010.Finally 263 cases were eventually enrolled with the exclusion of hospital-onset and thrombolysis with urokinase and referral.According to the improvement measures adopted,they were divided into three sub-groups: pre-reform(2011.1-2016.12),reform 1(2017.1-2017.12)and reform 2(2018.1-2018.10).Data of DNT,symptomatic intracranial hemorrhage(SICH),MRS score at 3 months of onset and 3 months of death were collected.Results:1.The improved procedure significantly shortened the door-to-needle time(DNT),and the difference was statistically significant(P values were less than 0.001).2.There was significant difference in MRS scores among the three subgroups(P=0.017),.3.There was no significant difference in symptomatic intracranial hemorrhage(P=0.532)and mortality.(P=0.198)Among the three subgroups,suggesting that the improvement of thrombolytic process did not lead to the increase of symptomatic intracranial hemorrhage and mortality.Conclusion: By improving the intravenous thrombolysis process(using green channel assessment form,backup stroke toolkit in emergency department,THRIVE scale to assess the risk of intracranial hemorrhage,no waiting for laboratory results,quickly obtain the results of cranial CT,regular quality control meetings),the door-to-needle time(DNT)can be significantly reduce.The above measures are simple and feasible,and can be popularized in grass-roots hospitals.2.Shortening door-to-needle time(DNT)did not increase the incidence of symptomatic intracranial hemorrhage and death. |
PDF Full Text Request