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目的探讨控制院内延迟时间(DNT)对缺血性卒中静脉溶栓效果的影响。方法收集台州市9家基层医院168例4.5h内接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的急性缺血性卒中患者临床资料,统计DNT和各控制因素的平均时间;采用滚动平均时间追踪法,以2014年10月为界对可控因素进行质量管理,分析质量管理前后基线数据、DNT相关因素,并作疗效评估。结果质量管理后,DNT从(79.50±26.97)min缩短为(68.64±24.30)min(P<0.05),DNT≤60min的比例从35.29%上升至40.91%,90d改良Rankin量表(mR S)<2分的比例从48.0%上升至60.6%。“到院至谈话”“到院至病房”“完成CT检查至用药”等时间均明显缩短(均P<0.05)。结论对影响静脉溶栓DNT的可控因素进行质量管理,能明显缩短DNT、改善卒中患者预后,可在基层医院实施并推广。
Objective To investigate the effect of controlling the delay in hospital (DNT) on the effect of intravenous thrombolysis in ischemic stroke. Methods The clinical data of 168 acute ischemic stroke patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in 168 patients of 9 primary hospitals in Taizhou City were collected. The average of DNT and the control factors Time. Using the rolling average time tracking method, quality control of controllable factors was carried out in October 2014. Baseline data before and after quality management and related factors of DNT were analyzed and the curative effect was evaluated. DNT decreased from (79.50 ± 26.97) min to (68.64 ± 24.30) min (P <0.05), and DNT decreased from 35.29% to 40.91% after the quality management. The 90s modified Rankin Scale (mR S) The proportion of 2 points increased from 48.0% to 60.6%. “To hospital to talk ” “to hospital to ward ” “to complete CT examination to medication ” and other time were significantly shorter (both P <0.05). Conclusions The quality control of the controllable factors affecting the intravenous thrombolytic DNT can significantly shorten the DNT and improve the prognosis of stroke patients and can be implemented and promoted in primary hospitals.