探讨院前急救与急诊绿色通道对急性缺血性脑卒中(AIS)患者临床救治的应用效果。

对南京鼓楼医院急诊科2015年10月至2018年2月实施卒中院前急救、绿色通道制度化前后确诊为AIS的583例患者进行回顾性研究，其中男性319例，女性264例；年龄28～92岁，平均年龄(69.40±13.35)岁。分为制度实施前的对照组(n＝246)和制度实施后的联合治疗组(n＝337)。记录患者诊治过程时间点，比较两组静脉溶栓、血管内介入治疗或桥接治疗例数、急诊就诊到溶栓的时间(DNT)、出/入院美国国立卫生研究院卒中量表(national institute of health stroke scale，NIHSS )评分、住院天数和预后，对治疗效果进行评估。

实施卒中院前急救、绿色通道后，静脉溶栓例数、DTN<60 min达标率增加，差异有统计学意义(P<0.05)。较之对照组，联合治疗组患者从急诊入院到溶栓的各个时间段耗时减少，无显著后遗症患者例数增多，且差异有统计学意义(P<0.05)。但在血管介入或桥接治疗例数、死亡患者例数和住院天数方面，两组间比较无统计学意义(P>0.05)。

卒中院前急救、绿色通道的应用，有助于优化AIS诊疗流程，缩短DNT，有利于改善患者预后。

To investigated the application effect of combined pre-hospital rescue and Green channel in acute ischemic stroke(AIS) patient treatment.

Patients who definite diagnosis is AIS before or after pre-hospital rescue and Green channel conducting in Emergency department of Drum tower hospital of Nanjing from October 2015 to February 2018 were recruited in present retrospective study. There were 583 patients enrolled in our research. Among them, male is 319 and female is 264.The age range of included patients is 28 to 92 years old, average of age is 69.40±13.35. All patients were divided into observation control group(n=246) which before the institutional implemented and combination therapy group(n=337) which after the institutional implemented. The each timepoint of AIS patient was recorded in the course of diagnosis and treatment. The number cases of intravenous thrombolysis, intravascular interventional therapy, door to needle time(DNT), National Institutes of Health Stroke Scale(NIHSS)scores when admission or discharge, days of hospital stay and prognosis were compared between these two groups.

Since pre-hospital rescue and Green channel were implemented, the amount of intravenous thrombolysis was elevated and the rate of DNT achieving standard (shorter than 60 min)was increased significantly (P<0.01). Compared with observation control group, the time spent in each phase of enroll hospital in combination therapy group was decreased and the number of discharged patient without sequela was increased obviously (P<0.01). However, there was no obvious statistical difference in the cases of intravascular interventional therapy, mortality and days of hospital stay between these two groups (P>0.05).

Application with combined pre-hospital rescue and Green channel improve the procedure of diagnosis and treatment in AIS obviously, shorten DNT effectively and improve AIS patient’s outcome.