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目的 探讨精益管理在控制急性缺血性脑卒中(AIS)患者静脉溶栓门-针时间(DTN)中的作用.方法 采用双向性队列研究方法,以浙江省台州市中心医院神经内科经重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗的AIS患者为研究对象,回顾性分析2013年1月至2014年3月收治AIS患者(常规组,22例)的常规溶栓流程,并制定精益管理方案,以2014年7月至2016年1月施行精益管理溶栓流程后的患者为精益组(33例).比较两组患者DTN、入院到CT检查时间(DTCT)、入院到CT报告时间(DTCT报告)、入院到凝血酶原报告时间(DTPT)、DTN控制在60 min内的比例、溶栓后美国国立卫生研究院卒中量表(NIHSS)评分改善＞2分的比例、症状性脑出血及脑疝发生率.结果 两组患者性别、年龄、发病到来院时间、NIHSS评分及既往史等一般资料比较差异均无统计学意义,说明两组资料均衡,具有可比性.与常规组比较,精益组DTN明显缩短(min:64.73±23.65比84.29±40.81,t=2.151,P=0.037),DTPT明显缩短(min:38.12±16.53比44.90±7.49,t=2.048,P=0.046),DTN控制在60 min内的患者比例明显提高(66.7％比18.2％,x2=11.000,P=0.001),而两组其他指标比较差异无统计学意义.结论 精益管理可以有效缩短AIS患者溶栓治疗的DTN,并有助于将DTN控制在60 min内,且未增加溶栓风险,可以作为AIS精益管理的一种有效工具.“,”Objective To study the application of precise management on controlling the door-to-needle (DTN) time in patients with acute ischemic stroke (AIS).Methods A consecutive two-way cohort study was conducted.The patients with AIS treated with recombinant tissue-type plasminogen activator (rt-PA) for thrombolytic therapy admitted to Department of Neurology of Taizhou Central Hospital in Zhejiang Province were enrolled.Conventional thrombolysis process in patients with AIS (conventional control group,n =22) from January 2013 to March 2014 was retrospectivelyanalyzed,during which the precise management was planned;the patients received precise management from July 2014 to January 2016 were served as precise management group (n =33).The time of DTN,door-to-CT (DTCT),door-to-CT report (DTCT report),and door-to-prothrombin report (DTPT),as well as the percentage of DTN within 60 minutes,National Institutes of health stroke scale (NIHSS) improvement more than 2,and incidence of symptomatic cerebral hemorrhage and cerebral hernia in both groups were compared.Results There was no significant difference in general data including gender,age,time from onset to hospital,NIHSS,and previous history between the two groups,indicating that the data in both groups were balanced with comparability.Compared with conventional control group,the time of DTN in precise management group was significantly shortened (minutes:64.73 ± 23.65 vs.84.29 ± 40.81,t =2.151,P =0.037),DTPT was significantly shortened (minutes:38.12 ± 16.53 vs.44.90±7.49,t =2.048,P =0.046),the percentage of DTN time controlled in 60 minutes was significantly increased (66.7％ vs.18.2％,x2 =11.000,P =0.001),but no significant difference in other parameters was found between the two groups.Conclusions Precise management can shorten the DTN time of AIS patients with rt-PA thrombolytic therapy effectively,raising the percentage of DTN time within 60 minutes without risk of thrombolysis.It can be used as an effective tool for AIS precise organization management.