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背景对急性缺血性脑卒中的适宜患者采取血管内治疗具有临床疗效,但这一治疗方法受时间窗限制。目的通过对缺血性脑卒中患者血管内治疗流程现状进行调查,分析产生院内延迟的原因,以提出相应的解决措施。方法采用自行设计的《某三甲医院缺血性脑卒中血管内治疗流程调查表》,对2014年11月—2015年4月在某三甲医院接受血管内治疗的缺血性脑卒中患者32例进行跟踪调查,内容包括患者的一般资料、临床特征、到达急诊-开始股动脉穿刺的各环节时间及流程中影响院内总时间关键事件的记录。结果 32例患者到达急诊-开始股动脉穿刺的平均时间为(171.8±52.5)min,与90 min的国际标准时间比较差异有统计学意义(P<0.05)。其中首先呼叫动脉溶栓组医师与首先呼叫静脉溶栓组医师患者到达急诊-获得动脉溶栓组医师会诊的平均时间分别为(11.7±6.8)、(66.9±53.2)min,到达急诊-开始股动脉穿刺的平均时间分别为(143.9±26.1)、(199.6±58.0)min;在CT之前进行心电图检查与在CT之后进行心电图检查患者到达急诊-到达CT室的平均时间分别为(63.1±47.3)、(31.9±12.3)min。结论缺血性脑卒中患者血管内治疗院内延迟现象严重,医院应完善脑卒中组织化管理的相关政策与制度,不断改进绿色通道质量控制机制,以缩短院内延迟时间。
Background The endovascular treatment of patients with acute ischemic stroke has clinical efficacy, but this treatment is limited by the time window. Objective To investigate the current status of endovascular treatment in patients with ischemic stroke and analyze the causes of delayed hospitalization so as to propose corresponding solutions. Methods A self-designed questionnaire of endovascular treatment of ischemic stroke in a top three hospital was conducted. Thirty-two patients with ischemic stroke receiving endovascular treatment in a top three hospital from November 2014 to April 2015 were enrolled in this study. Follow-up survey, including the patient’s general information, clinical characteristics, to reach the emergency - the beginning of the femoral artery puncture all aspects of the time and process of the hospital total time critical events record. Results The average time of arrival of the femoral artery puncture in the 32 patients was (171.8 ± 52.5) min, with a significant difference from the 90 min international standard time (P <0.05). Among them, the average time for first consultation between physician and arterial thrombolysis physician who reached the emergency-access arterial thrombolysis group was (11.7 ± 6.8) and (66.9 ± 53.2) min, respectively, reaching emergency-start stock The average time of arterial puncture was (143.9 ± 26.1) and (199.6 ± 58.0) min, respectively. The average time to reach the emergency department and to reach CT room before electrocardiogram and electrocardiogram after CT was (63.1 ± 47.3) , (31.9 ± 12.3) min. Conclusion Intravascular debridement in patients with ischemic stroke is serious. The hospital should improve the relevant policies and systems for the organization of stroke management, and continuously improve the quality control mechanism of green passage so as to shorten the hospital delay time.