Brewer L, Arize C, McCormack J, Williams D
Ir Med J. 2014 May;107(5):143-6.
Despite international consensus on the benefits of thrombolysis for ischaemic stroke (IS), it remains underused. Guidelines now recommend a door-to-needle time of 60 minutes. We reviewed the rate and timeliness of thrombolysis for IS at our hospital. 323 stroke patients presented between January 2011 and April 2012.Thirty patients (10.6% of IS) were thrombolysed, mean age was 68.5 years (42 to 88) and 19 patients (63%) were male. Thirty-six patients (12.7% of IS) were not thrombolysed despite arriving within the time-window and symptom resolution was the commonest reason (15 patients; 42%). Despite most thrombolysed patients (42%) presenting to the Emergency Department during daytime working hours, there were delays at each step of the acute care pathway. The mean time for stroke team review was 23 minutes (5-50). The mean door-to-CT and the door-to-needle times were 60 minutes (25-95) and 92 minutes (46-130) respectively. In parallel with national stroke incentives, local audit can highlight barriers to uptake and efficiency within thrombolysis services.
尽管国际上对于缺血性卒中（IS）溶栓治疗的益处已达成共识，但溶栓治疗的使用率仍然较低。目前的指南建议门到针时间为60分钟。我们回顾了我院IS溶栓治疗的比例和及时性。2011年1月至2012年4月期间，共有323例卒中患者就诊。30例患者（占IS患者的10.6%）接受了溶栓治疗，平均年龄为68.5岁（42至88岁），其中19例患者（63%）为男性。36例患者（占IS患者的12.7%）虽在时间窗内就诊但未接受溶栓治疗，最常见的原因是症状缓解（15例患者；42%）。尽管大多数接受溶栓治疗的患者（42%）在白天工作时间就诊于急诊科，但急性护理路径的每一步都存在延迟。卒中团队评估的平均时间为23分钟（5至50分钟）。平均门到CT时间和门到针时间分别为60分钟（25至95分钟）和92分钟（46至130分钟）。与国家卒中激励措施并行，局部审计可以突出溶栓服务中存在的应用障碍和效率问题。
