摘要目的:探讨计划-执行-检查-行动（PDCA）循环法优化卒中绿色通道建设对缩短急性缺血性卒中（AIS）患者到院至溶栓时间（DNT）和早期神经功能改善的影响。方法:回顾性分析首都医科大学良乡教学医院2018年6月至2019年9月120例AIS患者的临床资料。其中，60例患者是在绿色通道优化前入院治疗作为非优化组，60例患者是在绿色通道优化后入院治疗作为优化组。比较两组就诊至CT检查完成时间、CT检查完成至知情同意时间、知情同意至溶栓时间、DNT、DNT ≤ 60 min比例、溶栓后2 h和出院时美国国立卫生研究院卒中量表（NIHSS）评分、早期神经功能改善（ENI）率、住院时间、不良结局及病死率。结果:优化组CT检查完成至知情同意时间、DNT明显短于非优化组[29（14，36）min比37（21，54）min、55（45，67）min比76（54，93）min]，DNT ≤ 60 min比例明显高于非优化组[68.3%（41/60）比35.0%（21/60）]，ENI率明显低于非优化组[28.3%（17/60）比46.7%（28/60）]，差异均有统计学意义（ P<0.05或<0.01）；两组就诊至CT检查完成时间、知情同意至溶栓时间、溶栓后2 h NIHSS、住院时间、出院时NIHSS、不良结局率和病死率比较差异无统计学意义（ P>0.05）。 结论:PDCA循环法优化卒中绿色通道建设能有效缩短AIS患者DNT，可能对改善患者远期预后有重要意义。

abstractsObjective:To investigate the effect of optimized construction of green channel under plan-do-check-action (PDCA) on shortening the door-to-needle time (DNT) and improving early neurological improvement in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis.Methods:The clinical data of 120 patients with AIS treated with intravenous thrombolysis from June 2018 to September 2019 in Liangxiang Teaching Hospital of Capital Medical University were retrospectively analyzed. Among them, 60 patients were admitted to hospital before optimized as non-optimized group, and 60 patients were admitted to hospital after optimized as optimized group. The time from visit to CT examination completion, time from CT examination completion to informed consent, time from informed consent to intravenous thrombolysis, DNT, DNT ≤ 60 min ratio, National Institutes of Health stroke scale (NIHSS) score 2 h after intravenous thrombolysis and at discharge from hospital, early neurological improvement (ENI) rate, hospital stays, adverse outcomes and mortality were compared between 2 groups.Results:The time from CT examination completion to informed consent and DNT in optimized group were significantly shorter than those in non-optimized group: 29 (14, 36) min vs. 37 (21, 54) min, 55 (45, 67) min vs. 76 (54, 93) min, the DNT ≤ 60 min ratio was significantly higher than that in non-optimized group: 68.3% (41/60) vs. 35.0% (21/60), the ENI rate was significantly lower than that in non-optimized group: 28.3% (17/60) vs. 46.7% (28/60), and there were statistical differences ( P<0.05 or<0.01). There were no statistical differences in the time from visit to CT examination completion, time from informed consent to intravenous thrombolysis, NIHSS score 2 h after intravenous thrombolysis, hospital stays, NIHSS score at discharge from hospital, adverse outcomes rate and mortality between 2 groups ( P>0.05). Conclusions:The optimized construction of green channel under PDCA can effectively shorten the DNT of intravenous thrombolysis in patients with AIS, and may be significantly important for improving the long-term prognosis of patients.