Zhongguo cuzhong zazhi (Feb 2018)
院内卒中救治绿色通道建立、优化及区域救治网络的建立 Construction and Optimization of In-hospital Stroke Fast Channel and Construction of Regional Stroke Rescue Network
Abstract
目的 机械取栓时代，探索如何因地制宜建立急性卒中救治体系，让更多急性卒中患者能在时间窗 内及时到达有条件的医院，从而提高区域性急性卒中急诊救治的整体水平。 方法 从2014年开始，在院内及医院所在的区域，由单位行政部门及区域卫生行政部门牵头协调， 制定卒中救治的相关政策、规定，陆军军医大学第一附属医院神经内科作为技术主导，开展卒中诊治 的培训及帮助各级部门、医院建立相应的卒中救治流程、规范。观察我院卒中救治的关键绩效指标 及协作单位救治水平的改善情况。 结果 ①院内急诊通道的建立：由院长亲自参与，院医疗科作为卫生行政部门进行督导、协调，院内 参与卒中救治的急救部、神经内科、神经外科、神经影像科、检验科、心电图室及护理保障中心积 极参与，使急性缺血性卒中的入院-静脉溶栓（door-to-needle time，DNT）时间由绿色通道建立前的 71 mi n缩短至53 mi n，入院-动脉穿刺（door-to-puncture time，DPT）时间由104 min缩短至82 min，入院-血 运重建（door-to-revascularization time，DRT）时间由144 min缩短至117 min。②区域性卒中救治网络的建 立：极大提高我院急性缺血性卒中的救治能力，2014年本科静脉溶栓及血管内治疗总病例数为7例， 2016年提高到112例，区域内初级卒中中心的卒中防治关键绩效指标明显改善。 结论 院内卒中救治绿色通道及区域性卒中救治网络的建立，能提高卒中救治水平及救治率，改善 区域性卒中救治水平。应进一步改进卒中救治通道及网络并进行更大范围的推广。 Abstract: Objective In the context of current era of mechanical thrombectomy, this study is to explore how to establish acute stroke emergency system suited for local condition, make more stroke patients arrive at the qualified hospitals within the therapy time window, and increase the overall level of regional stroke rescue treatment. Methods Since 2014, the hospital and regional health administrative departments began to assist the local hospitals to make the policy and regulation of stroke rescue. The Department of Neurology of the Third Military University Affiliated First Hospital took the lead in aspect of technique, developed the training of diagnosis and treatment of stroke, provided assistance in establishing rescue workflow and assisted the collaborative hospitals to establish stroke emergency workflow and criterion. The improvement of key performance indicator (KPI) of acute ischemic stroke (AIS) care of our hospital, and change of stroke rescue level of collaborative hospitals were observed. Results (1) Establishment of stroke fast channel: the hospital director participated in the work. The department of medical affairs carried out the monitoring and coordination work. Many departme actively participated in the work, including Emergency, Neurology, Neurosurgery, Neuroimaging, Laboratory Medicine, ECG, and Nursing Security. The door-to-needle time (DNT) was shortened from 71 minutes before to 53 minutes now; the door-to-puncture time (DPT) was shortened from 104 minutes before to 82 minutes now; the door-to-revascularization time (DRT) was shortened from 144 minutes before to 117 minutes now. (2) Establishment of regional stroke rescue network: the level of AIS emergency care of our hospital got greatly improved. The total number of patients treated with IV thrombolysis and endovascular treatment increased from 7 in 2014 to 112 in 2016; the KPIs of stroke care in primary stroke center in this region also got improved significantly. Conclusion The establishment of in-hospital stroke fast channel and regional stroke rescue network can increase the level of stroke emergency care and regional stroke cure rate. It’s worthwhile to be further improved and widely promoted.
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