Liu Qiliang, Ranta Annemarei Anna, Abernethy Ginny, Barber P Alan
Trainee Intern, Department of Neurology, Auckland City Hospital and University of Auckland.
Neurologist and National Clinical Leader Stroke, Department of Neurology, Wellington Regional Hospital and University of Otago.
N Z Med J. 2017 Apr 7;130(1453):50-56.
To describe trends in treatment delays and short-term outcome over the first 18 months of the New Zealand stroke thrombolysis register.
The National Stroke Network introduced a central register of all ischaemic stroke patients treated with intravenous alteplase on January 1, 2015. The aim was to increase thrombolysis treatment rates and drive improvements in safety.
From January 1, 2015 to June 30, 2016, alteplase was given to 623 patients [344 men, mean (range) age 70 (22-98) years] out of a total of 8,857 ischaemic and unspecified stroke patients, giving a thrombolysis rate of 7.0%. Between the first and second halves of the audit, there were more patients thrombolysed [350 of 4,456 (7.9%) versus 273 of 4,401 (6.8%); p=0.001] and more treated within 60 minutes of hospital arrival [137 of 325 (42%) versus 71 of 250 (28%), p=0.001]. Door-to-needle time reduced from 77 minutes to 64 minutes (p=0.002) and the onset-to-treatment reduced from 162 minutes to 140 minutes (p=0.070). Rates of symptomatic intracranial haemorrhage (4.3% patients) and survival at day seven (93%) were stable.
There have been improvements in stroke thrombolysis rates and treatment delays in New Zealand hospitals since the institution of the National Stroke Network thrombolysis register. The Network will continue to adjust key performance indicators, and stroke thrombolysis targets for individual DHBs have been increased to 8% for 2017 and 10% for 2018.
描述新西兰卒中溶栓登记处前18个月治疗延迟和短期预后的趋势。
国家卒中网络于2015年1月1日建立了所有接受静脉注射阿替普酶治疗的缺血性卒中患者的中央登记处。目的是提高溶栓治疗率并推动安全性的改善。
从2015年1月1日至2016年6月30日，在总共8857例缺血性和未明确类型的卒中患者中，623例患者[344例男性，平均（范围）年龄70（22 - 98）岁]接受了阿替普酶治疗，溶栓率为7.0%。在审核的前半期和后半期之间，接受溶栓治疗的患者更多[4456例中的350例（7.9%）对4401例中的273例（6.8%）；p = 0.001]，且更多患者在入院后60分钟内接受治疗[325例中的137例（42%）对250例中的71例（28%），p = 0.001]。门到针时间从77分钟降至64分钟（p = 0.002），发病到治疗时间从162分钟降至140分钟（p = 0.070）。有症状性颅内出血的发生率（4.3%的患者）和第7天的生存率（93%）保持稳定。
自国家卒中网络溶栓登记处设立以来，新西兰医院的卒中溶栓率和治疗延迟情况有所改善。该网络将继续调整关键绩效指标，各地区卫生委员会的卒中溶栓目标在2017年提高到8%，2018年提高到10%。
