急诊科设立卒中中心对急性缺血性脑卒中患者救治效果的影响
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摘要
目的:探讨急诊科设立卒中中心在急性缺血性脑卒中(AIS)患者救治中的效果。方法:选择2017年10月1日至2018年9月30日在广西医科大学第一附属医院急诊科行静脉溶栓治疗的AIS患者,根据本院卒中中心成立前、后分为对照组(43例)和观察组(66例)。比较两组患者急诊静脉溶栓5个环节的时间,采用美国国立卫生研究院卒中量表(NIHSS)评分评估患者溶栓有效率;采用改良Rankin评分(mRS)评估患者溶栓后1个月神经功能恢复情况。结果:与对照组比较,观察组就诊至识别疑似AIS时间、就诊至完成采血时间、就诊至专科医师会诊时间、就诊至CT确诊时间及患者从入院至溶栓治疗时间(DNT)均显著缩短(均P<0.01)。观察组治疗有效率和溶栓后1个月神经功能良好率均较对照组明显提高(均P<0.05)。结论:在急诊科成立卒中中心能优化AIS救治流程,缩短患者在急诊科的滞留时间,改善患者的神经功能。
Objective:To investigate the effect of setting up stroke center in Department of Emergency on acute ischemic stroke(AIS).Methods:According to the pre-establishment and post-establishment of setting up stroke center in Department of Emergency,AIS patients who received intravenous thrombolysis in our hospital from October 2017 to September 2018 were divided into a control group(43 cases)and an observation group(66 cases).The time of five stages of emergency intravenous thrombolysis was compared.The effective rate of thrombolysis was evaluated by National Institutes of Health Stroke scale(NIHSS)score.The neurological function of patients was assessed by using improved Rankin score(mRS).Results:Compared with the control group,the time from visit to identification of suspected AIS,from visit to completion of blood collection,from visit to specialist consultation,from visit to CT diagnosis and from visit to thrombolysis treatment were shortened in the observation group(P<0.01).The effective rate and the rate of good neurological function after 1 month of thrombolysis in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Setting up stroke center in Department of Emergency could optimize the treatment process,shorten the residence time and improve the neurological function of AIS patients.
Objective:To investigate the effect of setting up stroke center in Department of Emergency on acute ischemic stroke(AIS).Methods:According to the pre-establishment and post-establishment of setting up stroke center in Department of Emergency,AIS patients who received intravenous thrombolysis in our hospital from October 2017 to September 2018 were divided into a control group(43 cases)and an observation group(66 cases).The time of five stages of emergency intravenous thrombolysis was compared.The effective rate of thrombolysis was evaluated by National Institutes of Health Stroke scale(NIHSS)score.The neurological function of patients was assessed by using improved Rankin score(mRS).Results:Compared with the control group,the time from visit to identification of suspected AIS,from visit to completion of blood collection,from visit to specialist consultation,from visit to CT diagnosis and from visit to thrombolysis treatment were shortened in the observation group(P<0.01).The effective rate and the rate of good neurological function after 1 month of thrombolysis in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Setting up stroke center in Department of Emergency could optimize the treatment process,shorten the residence time and improve the neurological function of AIS patients.
引文
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[6]VAN DISHOECK A M,DIPPEL D W,DIRKS M,et al.Measuring quality improvement in acute ischemic stroke care:interrupted time series analysis of door-toneedle time[J].Lancet,2012,379(9834):2364-2372.
[7]JAUCH E C,SAVER J L,ADAMS H P,et al.Guidelines for the early management of patients with acute ischemic stroke:aguideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2013,44(3):870-947.
[8]徐安定,丁燕,李牧.中国缺血性卒中早期静脉溶栓的现状、阻碍因素及改进策略[J].中国卒中杂志,2014,9(6):522-528.
[9]李桂香,王运良,闫波,等.急性缺血性脑卒中患者早期急救护理[J].中国实用神经疾病杂志,2012,15(15):94-95.
[10]刘江华,张剑锋,雷卓青,等.不同院前急救方式对急性脑卒中救治的影响[J].中国全科医学,2010,13(32):3663-3665.
[2]STURM J W,DEWEY H M,DONNAN G A,et al.Handicap after stroke:how does it relate to disability,perception of recovery,and stroke subtype:the north North East Melbourne Stroke Incidence Study(NEME-SIS)[J].Stroke,2002,33(3):762-768.
[3]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682.
[4]马玉宝,李成文,李卫东.急性脑卒中患者院前时间延误的影响因素分析[J].中国全科医学,2011,14(29):3380-3381.
[5]王素香,牛松涛,王拥军,等.急性脑血管病患者到院延迟因素的调查[J].中华内科杂志,2002,41(11):728-731.
[6]VAN DISHOECK A M,DIPPEL D W,DIRKS M,et al.Measuring quality improvement in acute ischemic stroke care:interrupted time series analysis of door-toneedle time[J].Lancet,2012,379(9834):2364-2372.
[7]JAUCH E C,SAVER J L,ADAMS H P,et al.Guidelines for the early management of patients with acute ischemic stroke:aguideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2013,44(3):870-947.
[8]徐安定,丁燕,李牧.中国缺血性卒中早期静脉溶栓的现状、阻碍因素及改进策略[J].中国卒中杂志,2014,9(6):522-528.
[9]李桂香,王运良,闫波,等.急性缺血性脑卒中患者早期急救护理[J].中国实用神经疾病杂志,2012,15(15):94-95.
[10]刘江华,张剑锋,雷卓青,等.不同院前急救方式对急性脑卒中救治的影响[J].中国全科医学,2010,13(32):3663-3665.