社区健康教育对急性脑梗死静脉溶栓治疗的影响
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摘要
目的探讨社区健康教育是否能缩短社区居民发生急性脑梗死后的院前延迟时间、提高时间窗内的就诊率,进而提高rt-PA静脉溶栓率。方法 2015年-2018年,在上海市浦东新区,选取东方医院周边两个自然社区分别作为干预社区和对照社区,对年龄≧65岁的户籍人群进行脑卒中高危人群的筛查。对干预社区筛查出的高危人群进行脑卒中早期救治的健康教育,对照组不开展。并对上述人群进行随访,比较发生卒中后院前延迟时间、时间窗内的就诊率、静脉溶栓治疗率的差异。结果随访期间,干预社区的高危人群中共有85人发生脑梗死,对照社区95人。干预社区有27人(31. 80%)接受溶栓治疗,对照社区14人(14. 70%);干预社区院前延迟时间中位数150 min,对照社区为285 min,差异显著。干预社区在4. 5 d内就诊人数为54人(63. 53%),9人(18%)拒绝溶栓治疗;对照社区45人(47. 36)在4. 5 h内就诊,16人(37. 2%)拒绝溶栓,差异显著。两社区脑梗死人群的就诊方式、入院交通工具的选择、就诊时的NIHSS评分、溶栓禁忌证、DNT差异不显著。结论在脑卒中高危人群中开展脑卒中早期救治的社区健康教育可缩短院前延迟时间、提高时间窗内就诊人数,对提高脑梗死静脉溶栓率有重要意义。
Objective To investigate whether community health education reduces time of delay in reaching the hospital after stroke onset,increases the proportion of patients arriving at the hospital within the time frame of rt-PA thrombolysis,and as a result,increases the proportion of rt-PA thrombolysis. Methods Two communities surrounding East Hospital were selected for this study. Subjects,aged 65 years and older and at a high risk for stroke,were educated with stroke early identification and treatment in one community( intervention group) between 2015 and 2018. Their counterparts in the other community( control group) did not receive this type of education but general health education. During the follow-up,time of delay in reaching a hospital after stroke onset,the proportion of patients arriving at the hospital within the time frame of rtPA thrombolysis,and the proportion of patients receiving rt-PA thrombolysis were compared between these two groups.Results During the follow-up,85 subjects had ischemic stroke and 27 received rt-PA thrombolysis( 31. 80%) in the intervention group. In comparison,95 subjects in the control group had ischemic stroke and 14( 14. 70%) received rt-PA thrombolysis,which was significantly different from that of the intervention group. The median time to present after stroke onset was 150 min in the intervention group compared to 285 min in the control group,which was significantly different. The number of subjects presenting in the hospital within 4. 5 h after stroke onset was 54( 63. 53%) in the intervention group with 9( 18%) refusing rt-PA thrombolysis and 45( 47. 36%) with 16( 37. 2%) refusing rt-PA in the control group. These were significantly different. There was no significant difference in the way they presented,selection of ways of transfer,NIHSS at presentation,contraindications of rt-PA thrombolysis,and door to needle time( DNT). Conclusion Community health education reduces time to visit the emergency department after stroke onset,increases the proportion of patients arriving at the hospital within the time frame of rt-PA thrombolysis,and increases the proportion of rt-PA thrombolysis for subjects at a high risk for ischemic stroke.
Objective To investigate whether community health education reduces time of delay in reaching the hospital after stroke onset,increases the proportion of patients arriving at the hospital within the time frame of rt-PA thrombolysis,and as a result,increases the proportion of rt-PA thrombolysis. Methods Two communities surrounding East Hospital were selected for this study. Subjects,aged 65 years and older and at a high risk for stroke,were educated with stroke early identification and treatment in one community( intervention group) between 2015 and 2018. Their counterparts in the other community( control group) did not receive this type of education but general health education. During the follow-up,time of delay in reaching a hospital after stroke onset,the proportion of patients arriving at the hospital within the time frame of rtPA thrombolysis,and the proportion of patients receiving rt-PA thrombolysis were compared between these two groups.Results During the follow-up,85 subjects had ischemic stroke and 27 received rt-PA thrombolysis( 31. 80%) in the intervention group. In comparison,95 subjects in the control group had ischemic stroke and 14( 14. 70%) received rt-PA thrombolysis,which was significantly different from that of the intervention group. The median time to present after stroke onset was 150 min in the intervention group compared to 285 min in the control group,which was significantly different. The number of subjects presenting in the hospital within 4. 5 h after stroke onset was 54( 63. 53%) in the intervention group with 9( 18%) refusing rt-PA thrombolysis and 45( 47. 36%) with 16( 37. 2%) refusing rt-PA in the control group. These were significantly different. There was no significant difference in the way they presented,selection of ways of transfer,NIHSS at presentation,contraindications of rt-PA thrombolysis,and door to needle time( DNT). Conclusion Community health education reduces time to visit the emergency department after stroke onset,increases the proportion of patients arriving at the hospital within the time frame of rt-PA thrombolysis,and increases the proportion of rt-PA thrombolysis for subjects at a high risk for ischemic stroke.
引文
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[11]Jin H,Zhu S,Wei JW,et al.Factors associated with prehospital delays in the presentation of acute stroke in urban China[J].Stroke,2012,43(2):362-370.
[12]Bi Q,Zhang Z,Zhang WW,et al.Study on prehospital time and influencing factors of stroke patients in 15 Chinese cities[J].Chingese Journal of Epidemiology,2006,27(11):996-999.
[13]Yang LM,Cheng X,Ling YF,et al.Intravenous thrombolysis treatment compliance with alteplase in patients with acute ischemic stroke in Huashan Hospital[J].Chin J Neural,2015,48(10):845-848.
[14]Zhou HJ,Wang S,Jin HM,et al.Multivariate analysis of pre-hospital delays in patients with acute cerebral infarction in primary level hospitals[J].Chinese Journal of Rural Medicine and Pharmacy,2018,25(14):9-10.
[15]Cong L,Min LQ,Yuan X,et al.Prehospital delay and its hffluencing factors in acute ischemic stroke in Fuxin area[J].Int J Cerebrovasc Dis,2018,26(3):172-177.
[16]Lin CB,Peterson ED,Smith EE,et al.Emergency medical service hospital prenotification is associated with improved evalustion and treatment of acute ischemic stroke[J].Circ cardiovasc Qual Outcomes,2012,5(4):514-522.
[17]Price CI,Rae V,Duckett J,et al.An observational study of patient characteristics associated with the mode of admission to acute stroke service in Northeast,England[J].Plo S One,2013,8(10):e76997.
[18]Minnerup J,Wersching H,Unrath M,et al.Effects of emergengcy medical services in patients with acute stroke care[J].Eur J Neurol,2014,21(10):1344-1347.
[2]张娴,张应宏.不同时间窗rt-PA静脉溶栓治疗椎-基底动脉系统脑梗死的疗效观[J].中风与神经疾病杂志,2018,35(7):595-598.
[3]Yang YM,Li G.Construction of the community health education and treatment plan for pre-hospital stroke delay[J].Health Education and Health Promotion,2016,11:311-313.
[4]国家卫生和计划生育委员会脑卒中筛查与防治工程委员会.卒中筛查与防治技术规范[J].中华神经科杂志,2014,47(3):199-203.
[5]Zhao QL,Li MH,Hao YH,et al.Development of a comprehensive educational protocol for pre-hospital stroke delay[J].Journal of Nursing Science Nov,2014,9(21):8-11.
[6]Ebinger M,Winter B,Wendt M,et al.Effect of the use of ambulancebased thrombolysis on time to thrombolysis in acute ischemic stroke:A randomized clinical trial[J].JAMA,2014,3(11):1622-1631.
[7]Fassbender K,Balucani C,Walter S,et al.Streamlining of prehospital stroke management:The golden hour[J].Lancet Neurol,2013,12(6):585-596.
[8]Nishijima H,Kon T,Ueno T,et al.Effect of educational television commercial on pre-hospital delay in patients with ischemic stroke[J].Neurol Sci,2016,37(1):105-109.
[9]Powers WJ,Rabinstein AA,Ackerson T,et al.2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/A-merican Stroke Association[J].Stroke,2018,49(3):e46-e110.
[10]Zhou Y,Wang YL,Wu D,et al.Pre-hospital transportation and admission delays of acute stroke patients:A sub-study from cerebrovascular events acute register database study[J].Chinese General Practice,2015,12(2):96-99.
[11]Jin H,Zhu S,Wei JW,et al.Factors associated with prehospital delays in the presentation of acute stroke in urban China[J].Stroke,2012,43(2):362-370.
[12]Bi Q,Zhang Z,Zhang WW,et al.Study on prehospital time and influencing factors of stroke patients in 15 Chinese cities[J].Chingese Journal of Epidemiology,2006,27(11):996-999.
[13]Yang LM,Cheng X,Ling YF,et al.Intravenous thrombolysis treatment compliance with alteplase in patients with acute ischemic stroke in Huashan Hospital[J].Chin J Neural,2015,48(10):845-848.
[14]Zhou HJ,Wang S,Jin HM,et al.Multivariate analysis of pre-hospital delays in patients with acute cerebral infarction in primary level hospitals[J].Chinese Journal of Rural Medicine and Pharmacy,2018,25(14):9-10.
[15]Cong L,Min LQ,Yuan X,et al.Prehospital delay and its hffluencing factors in acute ischemic stroke in Fuxin area[J].Int J Cerebrovasc Dis,2018,26(3):172-177.
[16]Lin CB,Peterson ED,Smith EE,et al.Emergency medical service hospital prenotification is associated with improved evalustion and treatment of acute ischemic stroke[J].Circ cardiovasc Qual Outcomes,2012,5(4):514-522.
[17]Price CI,Rae V,Duckett J,et al.An observational study of patient characteristics associated with the mode of admission to acute stroke service in Northeast,England[J].Plo S One,2013,8(10):e76997.
[18]Minnerup J,Wersching H,Unrath M,et al.Effects of emergengcy medical services in patients with acute stroke care[J].Eur J Neurol,2014,21(10):1344-1347.