1 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
2 Department of Community Health Sciences, University of Calgary, Calgary, Canada.
Int J Stroke. 2018 Apr;13(3):268-276. doi: 10.1177/1747493017743060. Epub 2017 Nov 15.
Background The effectiveness of thrombolysis is highly time dependent. For this reason, short target times have been set to reduce time to treatment from hospital arrival, which is called door-to-needle time. Summary of review There has been considerable work done at single centers and across multiple hospitals to improve door-to-needle time. There have been reductions of 8 to 47 min when applying one or more improvement strategies at single centers, and there have been many multi-hospital initiatives. The delays to treatment have been attributed to both patient and hospital factors, and strategies to address these delays have been proven to reduce door-to-needle time. The most effective strategies include pre-notification of arrival by Emergency Medical Services (EMS), single-call activation of stroke team, rapid registration process, moving the patient to computed tomography on EMS stretcher, and administration of alteplase in the scanner. There are many exciting areas of future direction including reduction of door-to-needle time in developing countries, improving pre-hospital response times, and improving the efficiency of endovascular treatment. Conclusions There is now a broad understanding of the causes of delays to fast treatment and the strategies that can be employed to improve door-to-needle time such that most centers could achieve median door-to-needle time of 30 min.
溶栓治疗的效果高度依赖时间。因此，设定了较短的目标时间，以减少从入院到开始治疗的时间，这被称为门到针时间。
在单中心和多医院层面已经做了大量工作来改善门到针时间。在单中心应用一种或多种改进策略时，可将时间缩短 8 至 47 分钟，并且有许多多医院的举措。治疗的延迟归因于患者和医院的因素，并且已经证明了针对这些延迟的策略可以减少门到针时间。最有效的策略包括由紧急医疗服务（EMS）预先通知到达、卒中团队的单次呼叫激活、快速登记流程、在 EMS 担架上将患者移动到计算机断层扫描（CT）、以及在 CT 机内给予阿替普酶。未来有许多令人兴奋的方向，包括减少发展中国家的门到针时间、改善院前反应时间以及提高血管内治疗的效率。
现在对于快速治疗延迟的原因以及可以用来改善门到针时间的策略有了广泛的认识，以至于大多数中心都可以实现中位数为 30 分钟的门到针时间。
