ปัจจัยที่มีผลต่อความล่าช้าในการให้ยาละลายลิ่มเลือดทางหลอดเลือดดำในผู้ป่วยโรคหลอดเลือดสมองตีบ หรืออุดตันเฉียบพลันที่มารับบริการที่ห้องฉุกเฉิน โรงพยาบาลพระจอมเกล้า จังหวัดเพชรบุรี

จุฑามาศ จิรัสย์ชำนะ พ.บ.

Authors

จุฑามาศ จิรัสย์ชำนะ พ.บ. Thai Board of Emergency Medicine Division of Emergency and Forensic Medicine Prachomklao Hospital, Phetchaburi

Keywords:

stroke fast track, delayed door-to-needle time

Abstract

Objective: To study the factors associated with delayed door-to-needle(DTN) time in patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator (rtPA) in emergency department, Prachomklao Hospital, Phetchaburi

Methods: This study was designed as a retrospective descriptive study. Medical records of acute ischemic stroke patients who are treated with intravenous rtPAin emergency department, Prachomklao Hospital were reviewed. The data collected from June 1, 2015 to May 31, 2018were reviewed and analyzed. Data analyseswere done by usingfrequency, percentage, mean, standard deviation, t-test independent and chi-square test.

Results: There were 53acute ischemic stroke patients enrolled to the stroke fast track andtreated with intravenous rtPA. Only 10 of 53 (18.9%) of patients received rtPA within 60 minutes. In group of non-delayed DTN time, the time of brain imaging, image interpretation, stroke team notification (p<.05); and imaging-to-needle timeespecially determining rtPA eligibility, i.e., time to make a medical decisionand time to order rtPA(p<.001) were less than in group of delayedDTN time withstatistical significance. The other factors (age, gender, stroke severity,arrival modeand weekday arrival) were not associated with delayed door-to-needle time.

Conclusion: Brain imaging, image interpretationand imaging-to-needle time were the factors associated with delayed DTN time among rtPA-treated patients with acute ischemic stroke in Prachomklao Hospital. Reduction time of these processesmay decrease DTN time which lead to a more efficient treatment and favorableclinical outcomes.

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