CAJ | 학술논문

目的：研究时间追踪对缺血性卒中患者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2013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2010年6月—2014年9月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、后入选病例的基线资料,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,其中启动静脉溶栓时间追踪前共纳入213例(追踪前组),启动后共纳入129例(追踪后组)。与追踪前组相比,追踪后组年龄>80岁的患者比例增高( P<0．05)、基线神经功能缺损程度较轻(P<0．05)、采用多模式影像学检查者比例增高(P<0．05)、DNT显著缩短(P<0．01),且以发病60 min内就诊者DNT缩短最为显著(P<0．01)。追踪前组ODT与DNT呈显著负相关(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。 DNT与ODT两者间无明显相关性(r=-0.013,P=0．885)。结论启动静脉溶栓时间追踪模式可缩短DNT,并可有效消除ODT对DNT的影响,提高缺血性卒中患者的静脉溶栓疗效,改善预后。
목적：연구시간추종대결혈성졸중환자정맥용전류정속도적영향,병명학입원지용전시간( door to needle time, DNT)여발병지입원시간( onset to door time, ODT)적상관성。방법전첨성수집2013년10월계동시간추종후정맥용전환자적시간추종표,병회고성분석계동시간추종전、후2010년6월—2014년9월접수정맥용전적결혈성졸중환자적림상자료。비교계동시간추종전、후입선병례적기선자료,병대ODT여DNT진행상관성분석。결과공납입342례정맥용전적결혈성졸중환자,기중계동정맥용전시간추종전공납입213례(추종전조),계동후공납입129례(추종후조)。여추종전조상비,추종후조년령>80세적환자비례증고( P<0．05)、기선신경공능결손정도교경(P<0．05)、채용다모식영상학검사자비례증고(P<0．05)、DNT현저축단(P<0．01),차이발병60 min내취진자DNT축단최위현저(P<0．01)。추종전조ODT여DNT정현저부상관(r=-0.169,P=0．015),차단잠성뇌결혈발작/졸중병사(β=-0.168,P=0．020)급ODT(β=-0.246,P=0．001)시영향DNT적독립위험인소。 DNT여ODT량자간무명현상관성(r=-0.013,P=0．885)。결론계동정맥용전시간추종모식가축단DNT,병가유효소제ODT대DNT적영향,제고결혈성졸중환자적정맥용전료효,개선예후。
Objective To study the effect of time tracking on intravenous thrombolysis for patients with ischemic stroke, and to confirm the correlation between door to needle time (DNT) and onset to door time (ODT). Methods Time tracking tables of patients with intravenous thrombolysis after time tracking was started in October 2013 were prospectively collected, and the clinical data of ischemic stroke patients with intravenous thrombolysis was retrospectively analyzed before and after the time tracking during June 2010 and September 2014. The baseline data of the selected patients before and after the time tracking was compared, and the correlation between DNT and ODT was also analyzed. Results A total of 342 is-chemic stroke patients with intravenous thrombolysis were recruited in this study, of whom 213 patients ( before tracking group, BT group) before the time tracking were included, and 129 patients ( after tracking group, AT group) after the time tracking were included. Compared with those in BT group, in AT group, the number of patients over 80 years old was big-ger (P<0. 05), baseline neurologic impairment degrees of patients were lighter (P <0. 05), the radio of using multi modes of imaging examination was bigger (P<0. 05);DNT was significantly shortened (P<0. 01), and the patients who visited the doctors within 60 min of the onset, had the most significantly shortened DNT (P<0. 01). In BT group, ODT and DNT showed a significantly negative correlation (r= -0. 169, P=0. 015), and transient ischemic attack/stroke histo-ry (β= -0. 168, P=0. 020) and ODT (β= -0. 246, P=0. 001) were independent risk factors affecting the DNT. There was no significant correlation between DNT and ODT (r= -0. 013, P=0. 885). Conclusion The time tracking mode of intravenous thrombolysis may shorten DNT, effectively eliminate the effect of ODT on DNT, and improve the therapeutic effect and prognosis of intravenous thrombolysis for patients with ischemic stroke.