Li Hongfei, Xu Dongjuan, Xu Yunyun, Wei Lianyan
Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China.
Front Surg. 2022 Apr 27;9:888015. doi: 10.3389/fsurg.2022.888015. eCollection 2022.
In this study, we retrospectively analyzed 795 AIS patients who received intravenous alteplase for thrombolytic therapy in one third-class hospital or three second-class hospitals in Dongyang City and sought to evaluate the effects of the medical community model on intravenous alteplase door-to-needle time (DNT) and prognosis of patients with acute ischemic stroke.
According to whether the medical community model is established or not, 303 AIS patients (204 cases from the third-class hospital and 99 cases from three second-class hospitals) were assigned to control group unavailable to the medical community model and 492 AIS patients (297 cases from the third-class hospital, and 195 cases from three second-class hospitals) into observational group available to the medical community model.
A higher thrombolysis rate, a shorter DNT, more patients with DNT ≤ 60 min and DNT ≤ 45 min, a shorter ONT, lower National Institutes of Health Stroke Scale (NIHSS) scores at 24 h, 7 d, 14 d, and modified Rankin scale (mRS) scores at 3 months after thrombolytic therapy, a shorter length of hospital stay, and less hospitalization expense were found in the observational group than the control group. Subgroup analysis based on different-class hospitals revealed that the medical community model could reduce the DNT and ONT to increase the thrombolysis rate of AIS patients, especially in low-class hospitals. After the establishment of the medical community model, the AIS patients whether from the third-class hospital or three second-class hospitals exhibited lower NIHSS scores at 24 h, 7 d, 14 d after thrombolytic therapy ( < 0.05). After a 90-day follow-up for mRS scores, a significant difference was only noted in the mRS scores of AIS patients from the third-class hospital after establishing the medical community model ( < 0.05). It was also found that the medical community model led to reduced length of hospital stay and hospitalization expenses for AIS patients, especially for the second-class hospitals.
The data suggest that the medical community model could significantly reduce intravenous alteplase DNT and improve the prognosis of patients with AIS.
本研究回顾性分析了在东阳市某三级医院及三家二级医院接受静脉注射阿替普酶溶栓治疗的795例急性缺血性卒中（AIS）患者，旨在评估医联体模式对急性缺血性卒中患者静脉注射阿替普酶的门针时间（DNT）及预后的影响。
根据是否建立医联体模式，将303例AIS患者（三级医院204例，三家二级医院99例）分配至未采用医联体模式的对照组，将492例AIS患者（三级医院２９７例，三家二级医院195例）分配至采用医联体模式的观察组。
观察组的溶栓率更高，DNT更短，DNT≤60分钟和DNT≤45分钟的患者更多，ONT更短，溶栓治疗后24小时、7天、14天的美国国立卫生研究院卒中量表（NIHSS）评分更低，3个月时的改良Rankin量表（mRS）评分更低，住院时间更短，住院费用更少。基于不同等级医院的亚组分析显示，医联体模式可缩短AIS患者的DNT和ONT，提高溶栓率，尤其是在低等级医院。医联体模式建立后，无论是来自三级医院还是三家二级医院的AIS患者，溶栓治疗后24小时、7天、14天的NIHSS评分均较低（P<0.05）。对mRS评分进行90天随访后，仅发现医联体模式建立后三级医院AIS患者的mRS评分有显著差异（P<0.05）。还发现医联体模式可缩短AIS患者的住院时间和住院费用，尤其是二级医院的患者。
数据表明，医联体模式可显著缩短静脉注射阿替普酶的DNT并改善AIS患者的预后。
