一种系统化的中风编码显著缩短了在磁共振成像筛查下使用静脉注射组织纤溶酶原激活剂的时间间隔。

A systemized stroke code significantly reduced time intervals for using intravenous tissue plasminogen activator under magnetic resonance imaging screening.

作者信息

Sohn Sang-Wook, Park Hyun-Seok, Cha Jae-Kwan, Nah Hyun-Wook, Kim Dae-Hyun, Kang Myong-Jin, Choi Jae-Hyung, Huh Jae-Taeck

机构信息

Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.

出版信息

J Stroke Cerebrovasc Dis. 2015 Feb;24(2):465-72. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.020. Epub 2014 Dec 15.

DOI:10.1016/j.jstrokecerebrovasdis.2014.09.020

PMID:25524016

Abstract

BACKGROUND

A stroke code can shorten time intervals until intravenous tissue plasminogen activator (IV t-PA) treatment in acute ischemic stroke (AIS). Recently, several reports demonstrated that magnetic resonance imaging (MRI)-based thrombolysis had reduced complications and improved outcomes in AIS despite longer processing compared with computed tomography (CT)-based thrombolysis.

METHODS

In January 2009, we implemented CODE RED, a computerized stroke code, at our hospital with the aim of achieving rapid stroke assessment and treatment. We included patients with thrombolysis from January 2007 to December 2008 (prestroke code period) and from January 2009 to May 2013 (poststroke code period). The IV t-PA time intervals and 90-day modified Rankin Scale (mRS) scores were collected.

RESULTS

During the observation period, 252 patients used IV t-PA under the CODE RED (MRI based: 208; CT based: 44). The remaining 71 patients (MRI based: 53; CT based: 18) received it before the implementation of our stroke code. After implementation of CODE RED, door-to-image time, door-to-needle time, and the onset-to-needle time were significantly reduced by 11, 18, and 22 minutes in MRI-based thrombolysis. Particularly, the proportion of favorable outcome (mRS score 0-2) was significantly increased (from 41.5% to 60.1%, P = .02) in poststroke than in prestroke code period in MRI-based thrombolysis. However, in ordinal regression, the presence of stroke code showed just a trend for favorable outcome (odds ratio, .99-2.87; P = .059) at 90 days of using IV t-PA after correction of age, sex, and National Institutes of Health Stroke Scale.

CONCLUSIONS

In this study, we demonstrated that a systemized stroke code shortened time intervals for using IV t-PA under MRI screening. Also, our results showed a possibility that a systemized stroke code might enhance the efficacy of MRI-based thrombolysis. In the future, we need to carry out a more detailed prospective study about this notion.

摘要

背景

卒中代码可缩短急性缺血性卒中（AIS）患者接受静脉注射组织型纤溶酶原激活剂（IV t-PA）治疗的时间间隔。最近，有几份报告表明，尽管基于磁共振成像（MRI）的溶栓治疗与基于计算机断层扫描（CT）的溶栓治疗相比处理时间更长，但在AIS中其并发症减少且预后改善。

方法

2009年1月，我们在我院实施了名为“红色代码”（CODE RED）的计算机化卒中代码，目的是实现快速的卒中评估和治疗。我们纳入了2007年1月至2008年12月（卒中代码实施前时期）以及2009年1月至2013年5月（卒中代码实施后时期）接受溶栓治疗的患者。收集了IV t-PA的时间间隔和90天改良Rankin量表（mRS）评分。

结果

在观察期内，252例患者在“红色代码”（基于MRI：208例；基于CT：44例）下使用了IV t-PA。其余71例患者（基于MRI：53例；基于CT：18例）在我们的卒中代码实施之前接受了治疗。实施“红色代码”后，基于MRI的溶栓治疗中，从入院到影像检查时间、入院到穿刺时间以及发病到穿刺时间分别显著缩短了11分钟、18分钟和22分钟。特别是，基于MRI的溶栓治疗中，卒中代码实施后良好预后（mRS评分0 - 2）的比例显著增加（从41.5%增至60.1%，P = 0.02），高于卒中代码实施前时期。然而，在有序回归分析中，在校正年龄、性别和美国国立卫生研究院卒中量表后，卒中代码的存在在使用IV t-PA 90天时仅显示出良好预后的趋势（优势比，0.99 - 2.87；P = 0.059）。