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目的:探讨急诊一体化运转模式在急性期脑梗死进行溶栓治疗的意义。方法:对比实施急诊一体化运转模式前后1年中脑梗死患者进行溶栓治疗的比例和开始溶栓时间;对比发病<3 h、发病<6 h但>3 h行rt-PA溶栓和发病>6 h脑梗死患者行内科保守治疗的三组患者治疗前、治疗后1 d、7 d、21 d的神经功能情况。结果:实施一体化前后一年中脑梗死患者进行溶栓治疗的比例分别为20.9%和38.3%,开始溶栓时间分别为(4.7±1.5)h和(3.8±1.6)h;发病<3 h、发病>3 h但<6 h进行rt-PA溶栓治疗前和发病>6 h保守治疗前三组的NIHSS评分无明显差异,治疗1d后NIHSS评分分别为(7.2±5.2)分、(8.2±5.5)分和(12.9±4.6)分,7 d后分别为(4.9±5.9)分、(6.8±6.3)分和(9.7±5.5)分,21 d后分别为(4.0±4.8)分、(5.7±4.6)分、(8.7±4.0)分,各组间均有明显差异(P<0.05)。结论:急救一体化运转模式能有效缩短脑梗死诊断时间,有助于患者得到及时的溶栓治疗,提高脑梗死患者的神经功能恢复程度。
Objective: To explore the significance of emergency operation mode of thrombolytic therapy in acute cerebral infarction. Methods: The proportion of thrombolytic therapy in patients with cerebral infarction in one year before and after the implementation of emergency integrated operation mode was compared with the time to start thrombolysis. Compared with the incidence of <3 h, the onset of rt-PA thrombosis and onset Neurological function in three groups of patients with> 6 h cerebral infarction before conservative treatment and 1 d, 7 d, 21 d after treatment. Results: The rates of thrombolytic therapy were 20.9% and 38.3% respectively in patients with cerebral infarction before and after integration and the time to initial thrombolysis was (4.7 ± 1.5) h and (3.8 ± 1.6) h, respectively , NIHSS scores of 3 h but less than 6 h before rt-PA thrombolysis and 6 h conservative treatment had no significant difference, NIHSS scores (7.2 ± 5.2), (8.2 ± 8.2), (4.9 ± 5.9) points and (6.8 ± 6.3) points and (9.7 ± 5.5) points respectively after 7 days and (4.0 ± 4.8) points after 21 days, respectively (5.7 ± 4.6) points and (8.7 ± 4.0) points respectively. There was a significant difference among all groups (P <0.05). Conclusion: The first-aid integrated operation mode can effectively shorten the time of diagnosis of cerebral infarction, help patients receive timely thrombolytic therapy and improve the recovery of neurological function in patients with cerebral infarction.