醫共體模式對急性腦梗死重組組織型纖溶酶原激活劑靜脈溶栓品質的影響

許蕓蕓 徐冬娟 李鴻飛 張為強 韋瀲滟 盧曉蓉

[摘要] 目的 探討醫共體模式對急性腦梗死（ACI）重組組織型纖溶酶原激活劑（rt-Pa）靜脈溶栓品質的影響。 方法 收集2017年1—12月醫共體模式前所收治的ACI患者為對照組（2775例），其中靜脈溶栓167例;收集2018年1—12月醫共體模式后的ACI患者為試驗組（2775例），其中靜脈溶栓249例。組建醫共體卒中團隊，優化流程，持續質量改進。比較兩組間ACI患者靜脈溶栓率、溶栓患者入院至溶栓時間DNT、DNT≤60 min的比例、溶栓患者的住院西藥費、總費用，并對發病至就診時間OCT與DNT相關性分析。 結果 5550例ACI患者，對照組靜脈溶栓率6.0%，低于試驗組的9.0%，差異有統計學意義（P<0.001），使溶栓患者DNT由59 min縮短為54 min（Z=2.492，P=0.013），DNT≤60 min患者比例從59.3%提高至72.3%（P<0.01），降低了溶栓患者住院西藥費（Z=2.507，P=0.012）、住院總費用（Z=2.602，P=0.009），試驗組中OCT與DNT負相關性減弱。 結論 應用醫共體管理能提升急性腦梗死的靜脈溶栓品質，即有效提高整體靜脈溶栓率、縮短DNT、提高DNT≤60 min的比例、降低住院西藥費、總費用，實現臨床醫療與公共衛生管理的雙贏。

[關鍵詞] 縣域醫療共同體;急性腦梗死;靜脈溶栓;入院至溶栓時間

[中圖分類號] R743.3? ? ? ? ? [文獻標識碼] C? ? ? ? ? [文章編號] 1673-9701（2021）25-0160-05

Effect of medical community model on intravenous thrombolysis quality of recombinant tissue-type plasminogen activator（rt-Pa） in patients with acute cerebral infarction

XU Yunyun? ?XU Dongjuan? ?LI Hongfei? ?ZHANG Weiqiang? ?WEI Lianyan? ?LU Xiaorong

Department of Neurology， Dongyang Hospital Affiliated to Wenzhou Medical University， Dongyang? ?322100， China

[Abstract] Objective To investigate the effect of medical community model on intravenous thrombolysis quality of recombinant tissue-type plasminogen activator（rt-Pa）in patients with acute cerebral infarction（ACI）. Methods The patients with ACI treated before the medical community model from January to December 2017 were selected as the control group（n=2775）， of which there were 167 cases of thrombolysis. The patients with ACI after the medical community model from January to December 2018 were selected as the study group（n=2775）， including 249 cases of thrombolysis. The stroke team of medical community was set up to optimize the process and the quality. The intravenous thrombolysis rate of ACI patients， the door to needle time（DNT） and the proportion of DNT≤60 min， the cost of western medicine and hospitalization cost were compared between the two groups， while the correlation between OCT and DNT was analyzed. Results In 5550 patients with ACI， the thrombolytic rate of the control group was 6.0%， which was lower than that of the experimental group （9.0%）， the difference was statistically significant（P<0.001）. The DNT of patients with thrombus was shortened from 59 min to 54 min（Z=2.492， P=0.013）， and the proportion of DNT≤60 min was increased from 59.3% to 72.3%（P<0.01）. The cost of western medicine（Z=2.507， P=0.012）and total cost of hospitalization（Z=2.602， P=0.009） were reduced. The negative correlation between OCT and DNT was weakened in the experimental group. Conclusion The application of medical community management can improve the quality of intravenous thrombolysis in ACI patients， which can effectively increase the rate of intravenous thrombolysis， shorten DNT， increase the proportion of DNT≤60 min， and reduce the cost of western medicine and total cost of hospitalization， thus realizing the win-win situation of clinical medical treatment and public health management.