Abstract: Background　Acute ischemic stroke（AIS） is one of the main causes of death and disability in the adult population，and recovery from it is a major health concern worldwide.Although considerable progress has been made in developing effective prevention and treatment，substantial challenges remain to improve the quality of care.In particular，concern has focused on the speed of emergency response.Intravenous thrombolytic therapy，as the only treatment proven to improve the outcome，is accessible in only a minority of such patients.Objective　To investigate the effects of optimized intravenous thrombolytic process on door-to-needle time（DNT）in AIS patients and on the construction of stroke center.Methods　We enrolled 186 AIS patients with recombinant tissue-type plasminogen activator therapy from Department of Neurology，Haining People's Hospital，and divided them into conventional group（97 treated with conventional thrombolytic process from November 2015 to March 2018），and optimization group（89 treated with optimized thrombolytic process from April to November 2018）.General demographic data，onset-to-door time，door-to-CT time，door-to-laboratory time，DNT，onset-to-thrombolysis time，incidence of symptomatic cerebral hemorrhage，pre- and post-24 hour-thrombolysis and discharge NIHSS scores 〔functional improvement was defined as ΔNIHSS（the difference between post- and pre-treatment NIHSS score）≥4〕，and 3-month post-discharge modified Rankin Scale（mRS） score were obtained and compared between the two groups.Results　The optimization group showed lower average admission NIHSS score（P<0.05）.Two groups had no significant differences in average onset-to-door time and discharge NIHSS score，incidence of symptomatic cerebral hemorrhage，and response rate（P>0.05）.The optimization group had lower average door-to-CT time，door-to-laboratory time，DNT，and onset-to-thrombosis time，and higher prevalence of DNT<60 min，as well as lower average 3-month post-discharge mRS score（P<0.05）.Conclusion　The optimized intravenous thrombolytic process is worth promoting as it can effectively shorten DNT，and help to control DNT within 60 minutes，as well as improve the long-term prognosis，without increasing the risk of thrombolytic intracerebral hemorrhage.

Key words: Stroke, Brain infarction, Thrombolytic therapy, Prognosis, Stroke center

摘要： 背景　急性缺血性脑卒中（AIS）是成年人死亡和致残的主要原因之一，如何恢复是全世界的一个主要健康问题。尽管在有效预防和治疗方面取得了相当大的进展，但仍面临着重大挑战，特别是急诊处理，静脉溶栓治疗是唯一一种改善患者预后的方法，但只有少数患者能使用。目的　探讨优化静脉溶栓流程对AIS患者入院至静脉溶栓用药时间（DNT）的影响及对高级卒中中心建设的作用。方法　收集2015年11月—2018年11月海宁市人民医院收治的采用重组组织型纤溶酶原激活物（rt-PA）静脉溶栓治疗的AIS患者186例为研究对象，根据时间进行分组，2015年11月—2018年3月患者采用常规溶栓流程为常规组，2018年4—11月患者接受优化静脉溶栓流程为优化组。比较两组患者一般资料、发病至就诊时间（OTD）、入院至CT检查时间（DTI）、入院至化验检验时间（DTL）、DNT、溶栓距发病时间（TP_WINDOW）、症状性脑出血（sICH）发生率，入院时、溶栓24 h及出院时评价美国国立卫生研究院卒中量表（NIHSS）评分，以ΔNIHSS评分≥4分为有效，出院后3个月临床结局采用改良Rankin量表（mRS）评定。结果　优化组入院时NIHSS评分低于常规组（P<0.05）。常规组与优化组患者OTD、sICH发生率、有效率、出院时NIHSS评分比较，差异均无统计学意义（P>0.05）；优化组患者DTI、DTL、DNT、TP_WINDOW、出院后3个月mRS评分低于常规组，DNT<60 min所占比例高于常规组（P<0.05）。结论　优化静脉溶栓流程可以有效缩短AIS患者DNT，并有助于DNT达标控制在60 min内，未增加溶栓出血风险且影响远期预后，值得推广。

关键词: 卒中, 脑梗死, 血栓溶解疗法, 预后, 卒中中心