提升缺血性腦中風病人緊急照護品質

Optimization of Effective Acute Ischemic Stroke Care

腦中風是台灣三大死因，雖然自2005年死亡人數有下降，但是仍然要確保病人能及時接受治療，以增加康復的機會。本專案小組分析2013年1月至12月缺血性腦中風病人60分鐘內接受靜脈血栓溶解劑治療比率為50%，靜脈血栓溶解劑施打率為1.6%。藉由成立腦中風跨領域照護團隊、建置「急性缺血性腦中風病人血栓溶解劑處置標準作業程序」、「中風啟動紀錄查核單」及「腦中風治療時效流程圖」、結合救護技術員(EMT)線上救護通報流程、進行急性缺血性腦中風到院前後醫療處置教育訓練。2014年及2015年缺血性腦中風病人60分鐘內接受靜脈血栓溶解劑治療比率提升至75%及81.8%，靜脈血栓溶解劑施打率提升為7.3%及7.6%。藉由此專案之執行，提供醫護理人員實際依循之辦法，並提升缺血性腦中風病人緊急照護品質，保障病人安全與提昇照護品質。

Acute ischemic stroke (AIS) is the third leading cause of death in Taiwan. Although the number has dropped since 2005, efforts are still being made to ensure immediate medical treatment. This paper examines whether the implemented strategies are associated with the number of patients receiving the earliest treatment. The strategies included establishing a multidisciplinary AIS care team, developing a standard operating procedure for the use of thrombolytic agents, developing a stroke alert assessment checklist and protocol, ensuring a smooth contact of EMT personnel with the receiving hospital, and finally, providing continuous training and education for the AIS care team. The number of patients who were given thrombolytic therapy and t-PA within 60 minutes was analyzed. In 2013, prior to program implementation, patients who were treated with thrombolytic and t-PA were 50% and 1.6%, respectively. After initiation of the program, patients who received thrombolytic therapy had increased to 75% and 81.8% in 2014 and 2015, respectively. Consistent with this finding, intravenous t-PA had increased to the respective 7.3% and 7.6%. Although a stroke program such as the one described is encouraging, increasing public awareness and optimizing smooth functioning of AIS from prehospital to admission care is essential for successful treatment.