急诊快捷流程在老年急性脑出血救治中的应用
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摘要
目的探讨急诊快捷流程在老年急性脑出血救治中的应用效果。方法收集2014年1月~2015年2月四川省内江市第二人民医院急诊科收治的90例老年急性脑出血患者临床资料,依据急诊流程不同进行临床分组,对照组40例采用常规急诊救治流程,观察组50例采用急诊快捷救治流程。观察两组患者接诊到确诊时间、急救实施时间、术前准备时间,急救前后GCS评分、NIHSS评分,急救后日常生活能力评价情况,手术并发症情况。结果观察组患者接诊到确诊时间[(19.6±4.6)min]、急救实施时间[(12.8±2.8)min]、术前准备时间[(26.4±5.1)min]均短于对照组[(27.5±5.6)、(17.8±4.0)、(31.8±6.0)min],差异均有统计学意义(P<0.05)。观察组和对照组急救前GCS[(7.7±1.2)比(7.6±1.1)分]、NIHSS评分[(33.9±5.6)比(33.7±5.2)分]差异均无统计学意义(P>0.05),急救后对照组和观察组GCS[(10.0±1.4)、(12.7±1.5)分]、NIHSS评分[(23.8±3.3)、(16.3±3.0)分]均优于急救前(P<0.05),且观察组患者急救后GCS、NIHSS评分均优于对照组(P<0.05)。急救后观察组患者日常生活能力评价优于对照组,差异有统计学意义(P<0.05)。观察组患者手术并发症发生率(4%)低于对照组(25%),差异有统计学意义(P<0.05)。结论在老年急性脑出血救治中应用急诊快捷流程可以提高抢救效率,改善患者预后水平,降低并发症发生率,值得临床推广应用。
Objective To discuss the application effect of emergency quick process in the treatment of elderly acute cerebral hemorrhage. Methods Clinical data of 90 elder patients with acute cerebral hemorrhage treated in Department of Emergency, Neijiang No.2 People's Hospital of Sichuan Province from January 2014 to February 2015 were collected. According to the emergency process, patients were divided into the contol gorup(n=40) and the observation group(n=50). Patients in the control gorup were given conventional emergency treatment process, while patients in the observation group were given emergency quick process. The accepts time to diagnosis time, first aid implementation time,preoperative preparation time, GCS score and NIHSS score before and after first-aid, activity of daily living evaluation after first-aid, and operative complications in the two groups were observed. Results The accepts time to diagnosis time[(19.6±4.6) min], first aid implementation time [(12.8±2.8) min], preoperative preparation time [(26.4±5.1) min] of the observation group were lower than those of the control group [(27.5 ±5.6),(17.8 ±4.0),(31.8 ±6.0) min], the differences were statistical significance(P < 0.05). The GCS score [(7.7±1.2) vs(7.6±1.1) scores] and NIHSS score [(33.9 ±5.6) vs(33.7±5.2) scores] of the observation group and the control group before first-aid were not statistically significant differences(P > 0.05), the GCS score [(10.0±1.4) vs(12.7±1.5) scores] and NIHSS score [(23.8±3.3) vs(16.3±3.0) scores] of the observation group and the control group after first-aid were all better than before first-aid, and the GCS score and NIHSS score of the observation group after first-aid were better than those of the control group, with statistically significant differences(P < 0.05). The activity of daily living evaluation of the observation group after first-aid was better than that of the control group, with statistically significant difference(P < 0.05). The incidenct of operative complication of the observation group(4%) was lower than that of the control group(25%), with statistically significant difference(P < 0.05). Conclusion Application of emergency quick process in the treatment of elderly acute cerebral hemorrhage can enhance the rescue efficiency, improve prognostic level, reduce incidence of complications, which isv worthy of clinical application.
Objective To discuss the application effect of emergency quick process in the treatment of elderly acute cerebral hemorrhage. Methods Clinical data of 90 elder patients with acute cerebral hemorrhage treated in Department of Emergency, Neijiang No.2 People's Hospital of Sichuan Province from January 2014 to February 2015 were collected. According to the emergency process, patients were divided into the contol gorup(n=40) and the observation group(n=50). Patients in the control gorup were given conventional emergency treatment process, while patients in the observation group were given emergency quick process. The accepts time to diagnosis time, first aid implementation time,preoperative preparation time, GCS score and NIHSS score before and after first-aid, activity of daily living evaluation after first-aid, and operative complications in the two groups were observed. Results The accepts time to diagnosis time[(19.6±4.6) min], first aid implementation time [(12.8±2.8) min], preoperative preparation time [(26.4±5.1) min] of the observation group were lower than those of the control group [(27.5 ±5.6),(17.8 ±4.0),(31.8 ±6.0) min], the differences were statistical significance(P < 0.05). The GCS score [(7.7±1.2) vs(7.6±1.1) scores] and NIHSS score [(33.9 ±5.6) vs(33.7±5.2) scores] of the observation group and the control group before first-aid were not statistically significant differences(P > 0.05), the GCS score [(10.0±1.4) vs(12.7±1.5) scores] and NIHSS score [(23.8±3.3) vs(16.3±3.0) scores] of the observation group and the control group after first-aid were all better than before first-aid, and the GCS score and NIHSS score of the observation group after first-aid were better than those of the control group, with statistically significant differences(P < 0.05). The activity of daily living evaluation of the observation group after first-aid was better than that of the control group, with statistically significant difference(P < 0.05). The incidenct of operative complication of the observation group(4%) was lower than that of the control group(25%), with statistically significant difference(P < 0.05). Conclusion Application of emergency quick process in the treatment of elderly acute cerebral hemorrhage can enhance the rescue efficiency, improve prognostic level, reduce incidence of complications, which isv worthy of clinical application.
引文
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[13]廖亮,欧明亮,陈军辉.老年脑出血患者肺部感染物理治疗的疗效探讨[J].中华医院感染学杂志,2015,25(12):2805-2807.
[14]赵龙姝,雷鸣,时扣荣,等.不同浓度人血白蛋白对老年脑出血危重患者的疗效研究[J].临床急诊杂志,2015,16(5):373-375.
[15]Sansing LH,Harris TH,Welsh FA,et al.Toll-like receptor4 contributes to poor outcome after intracerebral hemorrhage[J].Ann Neurol,2011,70(4):646-656.
[16]姚红梅,董建文,邵谨利,等.186例脑出血发病原因及预后分析[J].浙江预防医学,2015,27(3):274-275.
[17]Huang M,Hu Y,Dong XQ,et al.The protective role of oxymatrine on neuronal cell apoptosis in the hemorrhagic rat brain[J].J Ethnopharmacol,2012,143(1):228-235.
[18]Zhu X,Tao L,Tejima-Mandeville E,et al.Plasmalemma permeability and necrotic cell death phenotypes after intracerebral hemorrhage in mice[J].Stroke,2012,43(2):524-531.
[19]林少云,毛淑云,陈惠兰,等.预见性护理对急性脑出血患者的效果及对并发症的预防作用[J].中国医药科学,2015,5(9):108-110.
[20]蒋令修,梁宇,陈文武,等.醒脑静注射液对脑出血患者血浆MMP-9及TIMP-1的影响[J].中国现代医生,2015,53(35):5-7.
[21]孙晓莉,武岳,秦敏,等.依达拉奉治疗急性脑出血的疗效及其对脑钠肽、和肽素水平的影响[J].疑难病杂志,2016,15(12):1215-1218.
[22]张丽娥,韩江全,张莉莎,等.急性脑出血患者的预见性护理分析[J].中国医药科学,2016,6(17):99-101,137.
[23]唐蕾,王红星,徐晓玉,等.基质金属蛋白酶-9基因多态性与长沙地区汉族人群脑出血的关系[J].研究中国现代医学杂志,2015,25(10):36-39.
[24]蒋令修,粱宇,陈文武,等.急性基底节脑出血IL-4、IL-6、IL-8及IL-10与周围脑组织水肿的相关性分析[J].中国现代医生,2015,53(34):25-27.
[25]曲大鹏,魏明龙.依达拉奉治疗急性脑出血的临床疗效及安全性评价[J].临床急诊杂志,2015,16(7):520-522.
[2]毕堃,陆斌,尹文伟,等.脑出血患者医院感染的危险因素分析[J].中华医学感染学杂志,2015,25(13):3052-3056.
[3]Ji R,Shen II,Pan Y,et al.China National Stroke Registy investigatiors,Risk score to predict hospital-acquired pneumonia after spontaneous intracerebralhemorrhage[J].Stroke,2014,45(9):2620-2628.
[4]Xu FL,Duan JJ,Zhang YII,et al.Risk factors for periventricular-intraventricular hemorrhage in premature infants treated with mechanical ventilation[J].Zhongguo Dang Dai Er Ke Za Zhi,2012,14(11):838-841.
[5]陈江利,邵高峰,陈飞,等.自发性脑出血患者医院感染病原菌分布与危险因素分析[J].中华医学感染学杂志,2015,25(2):379-381.
[6]Babu R,Bagley JH,Di C,et al.Thrombin and hemin as central factors in the mechanisms of intracerebral hemorrhageinduced secondary brain injury and as potential targets for intervention[J].Neurosurg Focus,2012,32(4):E8.
[7]刘娜娜,祝继原,戚基萍.脑出血后的炎症机制[J].医学综述,2015,21(10):1732-1735.
[8]Su X,Wang H,Zhu L,et al.Ethyl pyruvate ameliorates intracerebral hemorrhage induced brain injury through anti-cell death and anti-inflammatory mechanisms[J].Neuroscience,2013,245(12):99-108.
[9]Moxon-Emre I,Schlichter LC.Neutrophil depletion reduces bloodbrain barrier breakdown,axon injury,and inflammation after intracerebral hemorrhage[J].J Neuropathol Exp Neurol,2011,70(3):218-235.
[10]孙伟,钱忠心,刘卫东.弥散张量成像在高血压性脑出血后皮质脊髓束损伤中的应用研究[J].临床神经外科杂志,2015,12(3):230-234.
[11]Wang YC,Wang PF,Fang H,et al.Toll-like receptor 4antagonist attenuates intracerebral hemorrhage-induced brain injury[J].Stroke,2013,44(9):2545-2552.
[12]Rodriguez-Yanez M,Brea D,Arias S,et al.Increased expression of Toll-like receptors 2 and 4 is associated with poor outcome in intracerebral hemorrhage[J].J Neuroimmunol,2012,247(1/2):75-80.
[13]廖亮,欧明亮,陈军辉.老年脑出血患者肺部感染物理治疗的疗效探讨[J].中华医院感染学杂志,2015,25(12):2805-2807.
[14]赵龙姝,雷鸣,时扣荣,等.不同浓度人血白蛋白对老年脑出血危重患者的疗效研究[J].临床急诊杂志,2015,16(5):373-375.
[15]Sansing LH,Harris TH,Welsh FA,et al.Toll-like receptor4 contributes to poor outcome after intracerebral hemorrhage[J].Ann Neurol,2011,70(4):646-656.
[16]姚红梅,董建文,邵谨利,等.186例脑出血发病原因及预后分析[J].浙江预防医学,2015,27(3):274-275.
[17]Huang M,Hu Y,Dong XQ,et al.The protective role of oxymatrine on neuronal cell apoptosis in the hemorrhagic rat brain[J].J Ethnopharmacol,2012,143(1):228-235.
[18]Zhu X,Tao L,Tejima-Mandeville E,et al.Plasmalemma permeability and necrotic cell death phenotypes after intracerebral hemorrhage in mice[J].Stroke,2012,43(2):524-531.
[19]林少云,毛淑云,陈惠兰,等.预见性护理对急性脑出血患者的效果及对并发症的预防作用[J].中国医药科学,2015,5(9):108-110.
[20]蒋令修,梁宇,陈文武,等.醒脑静注射液对脑出血患者血浆MMP-9及TIMP-1的影响[J].中国现代医生,2015,53(35):5-7.
[21]孙晓莉,武岳,秦敏,等.依达拉奉治疗急性脑出血的疗效及其对脑钠肽、和肽素水平的影响[J].疑难病杂志,2016,15(12):1215-1218.
[22]张丽娥,韩江全,张莉莎,等.急性脑出血患者的预见性护理分析[J].中国医药科学,2016,6(17):99-101,137.
[23]唐蕾,王红星,徐晓玉,等.基质金属蛋白酶-9基因多态性与长沙地区汉族人群脑出血的关系[J].研究中国现代医学杂志,2015,25(10):36-39.
[24]蒋令修,粱宇,陈文武,等.急性基底节脑出血IL-4、IL-6、IL-8及IL-10与周围脑组织水肿的相关性分析[J].中国现代医生,2015,53(34):25-27.
[25]曲大鹏,魏明龙.依达拉奉治疗急性脑出血的临床疗效及安全性评价[J].临床急诊杂志,2015,16(7):520-522.