中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2014年
7期
460-463
,共4页
张圣%金信春%陈智才%楼敏
張聖%金信春%陳智纔%樓敏
장골%금신춘%진지재%루민
脑缺血%卒中%血栓溶解疗法%时间因素
腦缺血%卒中%血栓溶解療法%時間因素
뇌결혈%졸중%혈전용해요법%시간인소
Brain ischemia%Stroke%Thrombolytic therapy%Time factors
目的 探讨时间追踪对静脉溶栓流程速度的影响,并明确入院至溶栓时间(door to needle time,DNT)与发病至入院时间(onset to door time,ODT)的相关性.方法 前瞻性收集2012年10月启动时间追踪后静脉溶栓患者的时间追踪表,并回顾性分析启动时间追踪前、后2009年6月至2013年9月间接受静脉溶栓的缺血性卒中患者的临床资料.比较启动时间追踪前、后入选病例的基线特点,并对ODT与DNT进行相关性分析.结果 共纳入342例静脉溶栓的缺血性卒中患者.启动时间追踪前的静脉溶栓患者中,ODT与DNT呈明显负相关(r=-0.169,P=0.015),且短暂性脑缺血发作/卒中病史(β =-0.168,P=0.020)及ODT(β=-0.246,P=0.001)是影响DNT的独立危险因素.与启动时间追踪前相比,启动时间追踪后的静脉溶栓患者中,高龄者比例增高[19.4％(25/129)与10.3％(22/213);x2=5.552,P=0.018],基线神经功能缺损程度较轻[(11.0 ±6.3)分与(12.5±6.7)分;=2.065,P=0.040],采用多模式影像学检查者比例增多[63.6％(82/129)与51.6％(110/213);x2=4.638,P=0.031],DNT显著缩短[(87.6±33.2) min与(108.4 ±52.4) min;t=4.274,P =0.000],且以发病1h内就诊者DNT缩短最为显著[(90.3±21.0) min与(132.5±46.0) min;t=5.048,P=0.000],DNT与ODT两者间无明显相关性(r=-0.013,P=0.885).结论 启动时间追踪可缩短DNT,并可有效消除ODT对DNT的影响.
目的 探討時間追蹤對靜脈溶栓流程速度的影響,併明確入院至溶栓時間(door to needle time,DNT)與髮病至入院時間(onset to door time,ODT)的相關性.方法 前瞻性收集2012年10月啟動時間追蹤後靜脈溶栓患者的時間追蹤錶,併迴顧性分析啟動時間追蹤前、後2009年6月至2013年9月間接受靜脈溶栓的缺血性卒中患者的臨床資料.比較啟動時間追蹤前、後入選病例的基線特點,併對ODT與DNT進行相關性分析.結果 共納入342例靜脈溶栓的缺血性卒中患者.啟動時間追蹤前的靜脈溶栓患者中,ODT與DNT呈明顯負相關(r=-0.169,P=0.015),且短暫性腦缺血髮作/卒中病史(β =-0.168,P=0.020)及ODT(β=-0.246,P=0.001)是影響DNT的獨立危險因素.與啟動時間追蹤前相比,啟動時間追蹤後的靜脈溶栓患者中,高齡者比例增高[19.4％(25/129)與10.3％(22/213);x2=5.552,P=0.018],基線神經功能缺損程度較輕[(11.0 ±6.3)分與(12.5±6.7)分;=2.065,P=0.040],採用多模式影像學檢查者比例增多[63.6％(82/129)與51.6％(110/213);x2=4.638,P=0.031],DNT顯著縮短[(87.6±33.2) min與(108.4 ±52.4) min;t=4.274,P =0.000],且以髮病1h內就診者DNT縮短最為顯著[(90.3±21.0) min與(132.5±46.0) min;t=5.048,P=0.000],DNT與ODT兩者間無明顯相關性(r=-0.013,P=0.885).結論 啟動時間追蹤可縮短DNT,併可有效消除ODT對DNT的影響.
목적 탐토시간추종대정맥용전류정속도적영향,병명학입원지용전시간(door to needle time,DNT)여발병지입원시간(onset to door time,ODT)적상관성.방법 전첨성수집2012년10월계동시간추종후정맥용전환자적시간추종표,병회고성분석계동시간추종전、후2009년6월지2013년9월간접수정맥용전적결혈성졸중환자적림상자료.비교계동시간추종전、후입선병례적기선특점,병대ODT여DNT진행상관성분석.결과 공납입342례정맥용전적결혈성졸중환자.계동시간추종전적정맥용전환자중,ODT여DNT정명현부상관(r=-0.169,P=0.015),차단잠성뇌결혈발작/졸중병사(β =-0.168,P=0.020)급ODT(β=-0.246,P=0.001)시영향DNT적독립위험인소.여계동시간추종전상비,계동시간추종후적정맥용전환자중,고령자비례증고[19.4％(25/129)여10.3％(22/213);x2=5.552,P=0.018],기선신경공능결손정도교경[(11.0 ±6.3)분여(12.5±6.7)분;=2.065,P=0.040],채용다모식영상학검사자비례증다[63.6％(82/129)여51.6％(110/213);x2=4.638,P=0.031],DNT현저축단[(87.6±33.2) min여(108.4 ±52.4) min;t=4.274,P =0.000],차이발병1h내취진자DNT축단최위현저[(90.3±21.0) min여(132.5±46.0) min;t=5.048,P=0.000],DNT여ODT량자간무명현상관성(r=-0.013,P=0.885).결론 계동시간추종가축단DNT,병가유효소제ODT대DNT적영향.
Objective To explore the effect of time tracking on speed of tissue-type plasminogen activator treatment in patients with acute ischemic stroke,and the correlation between door to needle time (DNT) and onset to door time (ODT).Methods Time tracking tables had been prospectively collected since October 2012.The data of intravenous thrombolytic candidates with acute ischemic stroke were retrospectively reviewed from June 2009 to September 2013.Baseline characteristics and the correlation between ODT and DNT were assessed respectively before and after the implementation of time tracking.Results Three hundred and forty-two cases were finally included.Before the implementation of time tracking,ODT was negatively correlated with DNT (r =-0.169,P =0.015) ; Patients with transient ischemic attack (TIA)/stoke history (β =-0.168,P =0.020) and ODT (β =-0.246,P =0.001)accounted for the length of DNT independently.Since the implementation of time tracking,the elderly accounted for more (19.4％ (25/129) vs 10.3％ (22/213) ; x2 =5.552,P =0.018),the baseline nervous impairment was NIHSS scores (milder 11.0 ± 6.3 vs 12.5 ± 6.7 ; t =2.065,P =0.040),the proportions of patients taking multi-modality imaging were larger (63.6％ (82/129) vs 51.6％ (110/213) ; x2 =4.638,P =0.031) and the DNT decreased significantly ((87.6 ± 33.2) min vs (108.4 ± 52.4) min;t =4.274,P =0.000),which was especially seen in patients arrived within 1 hour after onset ((90.3 ±21.0) min vs (132.5 ± 46.0) min; t =5.048,P =0.000),and the previous inversely correlated DNT and ODT (r=-0.169,P=0.015) became irrelevant (r=-0.013,P=0.885).Conclusion Implementation of time tracking reduces DNT,and clears up the effect of ODT on DNT.
