急性脑梗死溶栓流程及临床实践PPT参考幻灯片.ppt

2013 AHA/ASA 指南：为简化优化溶栓流程提供支持 * 病史采集，体格检查和NIHSS评估：强调快速 选择必要的辅助检查 CT或MR平扫 血糖 氧饱和度 血电解质和肾功能* 血常规* 心肌缺血血液学指标* PT／INR／APTT* ECG* Jauch EC, et al. Stroke. 2013 Mar;44(3):870-947. 建立卒中中心，缩短DNT * 卒中中心组成项目 管理与支持 急性卒中小组 机构保障和支持 设立初级卒中中心主管，咨询相关报销 建立包括临床结果和质量改进指标的卒中登记 教育项目：公众和医护人员 支持卒中中心的认证程序 参与卒中医疗体系 书面治疗方案 EMS 急诊科 卒中单元 神经外科检查 影像检查：脑组织影像、脑血管影像以及心脏影像 实验室检查 康复治疗 卒中中心建立标准 Alberts MJ, et al. Jauch EC, et al. Stroke. 2011 Sep;42(9):2651-65. 王拥军等，中国卒中杂志2006年第6期：423-32 规范化诊疗流程 * 规范溶栓流程， 缩短DNT * * * 患者从入院到rt-PA治疗的时间≤ 60分钟的治疗人数2003年增加了19.5%，而2009年增加29.1% ，每年以1.6%的趋势增长，研究结果显示：与DNT ≥ 60分钟的患者相比，DNT ≤ 60分钟的患者院内死亡率和症状性颅内出血率显著降低，DNT≤ 60分钟获益更显著 From 2003 to 2009, the proportion of patients with a door-to-needle time 60 minutes increased modestly over time, from 19.5% in 2003 to 29.1% in 2009, with a trend line showing an increase of 1.6%/y. There was also an unadjusted relationship between the achievement of door-toneedle times 60 minutes and the duration of hospital participation in the GWTG-Stroke Program. The proportion of patients with door-to-needle times 60 minutes increased from 21.1% at the program baseline to 32.4% in year 6 or more of program participation. Data from acute ischemic stroke patients treated with tPA within 3 hours of symptom onset in 1082 hospitals participating in the Get With the Guidelines–Stroke Program from April 1, 2003, to September 30, 2009 were studied to determine frequency, patient and hospital characteristics, and temporal trends in patients treated with door-to-needle times 60 minutes. Among 25 504 ischemic stroke patients treated with tPA, door-to-needle time was 60 minutes in only 6790 (26.6%). Patient factors most strongly associated with door-to-needle time 60 minutes were younger age, male gender, white race, or no prior stroke. Hospital factors associated with 60 minute door-to-needle time incl