优化流程缩短DNT课件.pptVIP

;;静脉溶栓2015;;静脉溶栓、桥接治疗、血管内治疗;DNT≦60min 11例分析，均符合DNT6步骤最佳时间内;DNT ≧80min 9例分析 ，多在检验环节耽误;月份（N=27）;死亡人数分布;;;;;; 在排除相关病史用药史后，AIS静脉溶栓前不等待血小板和凝血功能指标联合其他优化措施，可显著缩短DNT，不增加slCH和7d内的死亡风险。 ;通过询问病史如血小板减少、肝肾功能异常、服用抗凝药等，可以早期判断患者是否可能存在血小板降低或凝血功能异常的情况。 Gottesman等指出预测PT、部分凝血活酶时间(PTT)是否正常的关键在于明确3个问题： (1)是否正在使用华法林治疗? (2)是否正在使用肝素或低分子量肝素治疗? (3)是否进行血液透析治疗?如果回答都是否定的，那么该方法预测PT、PTT正常的敏感度100％，特异度94．6％。;;Patients should receive endovascular therapy with a stent retriever if they meet all the following criteria (Class I; Level of Evidence A). (New recommendation): (a) prestroke mRS score 0 to 1, (b) acute ischemic stroke receiving intravenous r-tPA within 4.5 hours of onset according to guidelines from professional medical societies, (c) causative occlusion of the internal carotid artery or proximal MCA (M1), (d) age ≥18 years, (e) NIHSS score of ≥6, (f) ASPECTS of ≥6, and (g) treatment can be initiated (groin puncture) within 6 hours of symptom onset ;;The benefits of intravenous tPA in acute ischemic stroke are highly time-dependent. Because of the importance of rapid treatment, AHA/ASA guidelines recommend a door-to-needle (DTN) time of ≤60 minutes. Yet prior studies suggested fewer than 30% of intravenous tPA treated acute ischemic stroke patients in the United States were meeting this goal. To address this shortfall, Target: Stroke, a national initiative organized by the AHA/ASA, was launched in January 2010 to increase the proportion of stroke patients with DTN times ≤60 minutes (initial goal of ≥ 50%).;Improving Door-to-Needle Times in Acute Ischemic Stroke: Principal Results from the Target: Stroke Initiative. ISC 2014, LB12;Improving Door-to-Needle Times in Acute Ischemic Stroke: Principal Results from the Target: Stroke Initiative. ISC 2014, LB12;Target: CustomizableImplementation Tools;;;一项来自美国Target：Stroke项目共304家医院5460例接受tPA治疗患者的研究，旨在评估医院策??和缩短DNT时间的相关性。;While there have been concerns that attempting to achieve shorter DTN times may lead to rushed assessments, inappropriate