Eric Peterson 教授  美国杜克临床研究所 

　　<International Circulation>: What is the clinical significance of improving door to needle time for stroke? How can we improve door to needle (DTN) time for stroke? What is the threshold for this window of opportunity?

　　Dr. Peterson: Studies have clearly linked?timely treatment with tPA with lower mortality and better functional outcomes in acute ischemic stroke (AIS).?Based on this，?the current?guidelines recommend DTN times of <60 minutes from hospital arrival to treatment. Data now exists that?a national quality improvement effort in the US. DTN times in US can lead to improved outcomes， thus providing even more proof to the benefits of DTN <60 minutes.

　　《国际循环》：缩短卒中治疗的door-to-needle（DTN）时间的临床意义是什么？如果缩短？这一治疗时间窗的阈值是多少？

　　Peterson教授：大量研究已清晰表明急性缺血性卒中（AIS）患者使用tPA及时治疗可使死亡率降低，并有更好的功能结局改善。基于此，目前的指南推荐从患者到达医院到接受治疗的DTN时间<60 min。数据显示，美国国家质量改进计划在此方面做了很大努力。DTN时间缩短可改善患者结局，并为DTN时间<60 min的获益提供更多证据支持。

　　<International Circulation>: The current gaps existing between China and more developed counties in stroke management and research have been recently analyzed， what approach should we take to improve this situation??

　　Dr. Peterson: AIS is China’s the number one killer. Data from contemporary practice in China show that many patients eligible for tPA do not receive it and， of those treated， <25% get this treatment with the guideline directed DTN <60 minutes. Thus， there are large opportunities for improving the quality of care for AIS patients in China.

　　《国际循环》：近期，有分析当前中国和更发达国家在卒中管理方面的差距，您认为改变这种现状的措施有哪些？

　　Peterson教授：AIS是中国患者死亡的“头等杀手”。目前中国临床实践数据显示，很多适合使用tPA的患者未接受治疗；在已治疗患者中，不足25%能在指南推荐的DTN时间<60 min内接受治疗。因此，改善中国AIS患者的护理质量还有很大机会。

　　<International Circulation>: The status and tendency of stroke healthcare and research were introduced in the meeting， could you elaborate on that? What steps should be taken for increased innovative clinical research and implementation?

　　Dr. Peterson: The separation between research and clinical practice needs to dissolve. We need to integrate research into routine clinical care and use data collected from routine care to inform our research. And it’s abundantly clear， once we know ‘what works’ we need study community practice to be sure that these effective therapies are adopted.? And when gaps exist， like we saw for timely tPA in AIS， than we need large national quality improvement efforts to move the care needle and assure all patients are getting the very best， evidence based treatments.? ?

　　《国际循环》：卒中医疗和研究的现状和趋势在本次大会上有介绍，您能具体说一下吗？开展创新性的临床研究并成功实施的关键是什么？

　　Peterson教授：临床研究和临床实践之间的分离需要解决。我们需要将研究整合进常规临床护理中，并从中收集相关数据完成我们的研究。这是非常清楚的，一旦我们知道“哪些有用”，我们需要在临床实践中研究，以确保那些有效治疗措施能被使用。当存在差距时，就如我们看到的AIS患者需要使用tPA及时治疗，我们就要开展国家质量改进计划，努力缩短患者至治疗的时间，确保所有患者能得到基于证据的最佳治疗。