To investigate the effect of pre-hospital notification + in-hospital integrated thrombolysis model on the time from entering the hospital to thrombolytic agent entering the blood vessel (DNT) and curative effect of patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA).

The medical records of 201 patients with acute ischemic stroke (AIS) who were treated with rt-PA intravenous thrombolysis in Yantai Mountain hospital from January 1, 2017 to December 31, 2017 and from January 1, 2020 to December 31, 2020 were collected. According to whether the "pre-hospital notification + integrated thrombolysis mode" is constructed, the patients are divided into optimization group (106 cases) and control group (95 cases). The patients in the optimization group are divided into minor stroke group (62 cases) and non-minor stroke group (44 cases) according to the National Institutes of Health Stroke Scale (NIHSS) score ≤ 5 and > 5. Mann-Whitney U test was used to compare the changes of NIHSS scores between the two groups in terms of intravenous thrombolysis DNT, time from onset to admission, time from admission to blood drawing, time from admission to CT, time from admission to consent to thrombolysis signature, and the change of NIHSS score 1 day after thrombolysis（?NIHSS-1d), the change of NIHSS score 7 day after thrombolysis（? NIHSS-7d), the difference of modified Rankin Scale score 90 days after thrombolysis (mRS-90d), and the differences of intravenous thrombolysis DNT, time from onset to admission, time from admission to blood drawing, time from admission to CT, and time from admission to consent to thrombolysis signature between minor stroke group and non-minor stroke group were compared.

There was no significant difference in the time from onset to admission, the time from admission to blood drawing, and ?NIHSS-1d between the two groups (P＞0.05). Compared with the control group, the time from DNT and admission to consent to thrombolysis in the optimization group was significantly shorter [37 (28,48) min vs 50 (40,70) min; 34 (23,44) min vs 38 (27,55) min; Z=-5.769, -2.071, P=0.000, 0.038). ? NIHSS-7d in the optimization group changed significantly [3 (1,6) score vs 2 (0,5) score], and mRS-90 d score decreased significantly [0 (0,1) score vs 1 (0,2) score]. Both difference was statistically significant (Z=-2.043, -3.283, P=0.041, 0.001). Compared with the non-minor stroke group, the time from DNT and admission to consent to thrombolysis was significantly shorter in the minor stroke group [33 (28,44) min vs 40 (29,53) min; 31 (22,42) min vs 36 (25,50) min], and the difference was statistically significant (Z=-2.085, -2.011, P=0.037, 0.044).

the mode of pre-hospital notification + integrated thrombolysis in hospital can shorten the DNT of intravenous thrombolysis in patients with AIS, reduce the time at each time node, have obvious thrombolysis effect and improve the prognosis of patients; Thrombolysis time was shorter in patients with mild symptoms than in patients without minor stroke.