Department of Neurology, Klinikum Traunstein, Cuno-Niggl-Strasse 3, Traunstein,Germany.
Acta Neurol Scand. 2011 Jun;123(6):390-5. doi: 10.1111/j.1600-0404.2010.01413.x. Epub 2010 Aug 12.
Thrombolysis in stroke remains underutilized in daily practice. We analyzed the impact of a multimodal strategy on the rate of thrombolysis and specific procedure times during the implementation of a community hospital stroke unit.
During a period of 2 years before and after implementation of a stroke unit, we prospectively recorded all patients with thrombolysis and specific procedure times. Calculated door-to-needle time (DNT), door-to-CT time (DCT) and CT-to-needle time (CNT) were analyzed. All structural changes before and after the implementation were analyzed.
The number of patients with thrombolysis increased from 24 in 2005-2006 (4.8% of all admitted patients with ischemic stroke) to 95 in 2007-2008 (12.8%). DNT was significantly reduced from 62.2±36.1 to 38.5±22.2 min (P<0.001). DCT remained unchanged at 10.3±9.5 to 10.4±13.9 min (P=0.974), whereas CNT improved from 45.7±23.1 to 28.3±20.3 min (P=0.001). Several structural changes concerning staff, logistics, procedures and laboratory were identified which contributed to decreasing DNT.
A multimodal strategy including several structural changes enables the successful implementation of a community hospital stroke unit offering rapid access to thrombolysis with a very short DNT.
在日常实践中，溶栓治疗在中风患者中仍未得到充分应用。我们分析了在实施社区医院卒中单元过程中，采用多模式策略对溶栓治疗率和特定手术时间的影响。
在实施卒中单元前后的 2 年期间，我们前瞻性地记录了所有接受溶栓治疗的患者和特定手术时间。分析计算了门到针时间（DNT）、门到 CT 时间（DCT）和 CT 到针时间（CNT）。分析了实施前后所有结构变化。
溶栓患者人数从 2005-2006 年的 24 例（缺血性卒中入院患者的 4.8%）增加到 2007-2008 年的 95 例（12.8%）。DNT 从 62.2±36.1 分钟显著缩短至 38.5±22.2 分钟（P<0.001）。DCT 保持不变，仍为 10.3±9.5 分钟至 10.4±13.9 分钟（P=0.974），而 CNT 从 45.7±23.1 分钟缩短至 28.3±20.3 分钟（P=0.001）。确定了与人员、物流、程序和实验室有关的几个结构变化，这些变化有助于缩短 DNT。
包括多个结构变化的多模式策略可成功实施社区医院卒中单元，提供快速溶栓治疗机会，DNT 非常短。
