北京某三甲医院院前转运方式对急性卒中患者治疗延误的影响

发布时间：2018-07-09 20:42

本文选题：卒中 + 院前转运　；参考：《中国脑血管病杂志》2017年03期

【摘要】：目的探讨院前转运方式对急性卒中患者治疗延误的影响。方法前瞻性连续纳入2016年3月至8月首都医科大学宣武医院符合纳入标准的急性卒中患者255例,排除资料不全7例,获得有效病例248例。依据是否通过急救车转运到院,分为急救车组(88例)和非急救车组(160例),比较两组基线资料、院前情况、发病至到院时间、到院至评估时间、到院至CT检查时间、到院至静脉溶栓时间的差异,并分析急性卒中患者急救车利用的相关因素及院前转运方式选择的原因。结果 (1)248例患者急救车利用率为35.5%。急救车组患者年龄、冠心病比例、美国国立卫生研究院卒中量表(NIHSS)评分高于非急救车组[(65±11)岁比(61±11)岁、15.9%(14/88)比5.6%(9/160)、9(3,17)分比2(1,5)分],卒中比例低于非急救车组[23.9%(21/88)比37.5%(60/160)],组间差异均有统计学意义(均P0.05)。(2)急救车组与非急救车组的自我判断病情紧急与自我保健意识的差异均有统计学意义(均P0.01)。(3)与非急救车组相比,急救车组患者发病至到院时间,到院至评估时间、CT检查时间、静脉溶栓时间更短[102(64,150)min比136(86,230)min、3(1,8)min比7(4,11)min、15(18,23)min比16(22,27)min、(41±9)min比(50±10)min,均P0.05]。(4)Logistic回归结果显示,年龄大(OR=1.04,95%CI:1.01~1.08,P=0.01)、NIHSS评分高(OR=1.13,95%CI:1.08~1.19,P0.01)、患者或知情人判断病情紧急(OR=17.08,95%CI:5.78~50.41,P0.01)、不适会及时就诊(OR=38.13,95%CI:10.13~143.61,P0.01)、不适会自行服药(OR=6.82,95%CI:2.33~19.99,P0.01)的急性卒中患者更倾向于通过急救车转运到院。结论使用急救车可减少急性卒中患者的治疗延误,有自我保健意识者更易选择急救车转运。对卒中患者应加强利用急救车重要性的宣教。
[Abstract]:Objective to investigate the effect of pre-hospital transportation on treatment delay in patients with acute stroke. Methods from March to August, 2016, 255 patients with acute stroke were included in Xuanwu Hospital of Capital Medical University, including 7 patients who were excluded from incomplete data and 248 patients who were effective. According to whether the first aid vehicle was transferred to hospital, it was divided into two groups: the first aid vehicle group (88 cases) and the non-first aid vehicle group (160 cases). The baseline data of the two groups were compared. The pre-hospital conditions, the time from the onset to the hospital, the time from the hospital to the evaluation, and the time from the hospital to the CT examination were compared. The difference of thrombolytic time from hospital to intravenous thrombolysis was analyzed, and the related factors of emergency vehicle utilization and the reasons of choice of transport mode before hospital were analyzed. Results (1) the utilization rate of first aid vehicle in 248 patients was 35.5. Age, coronary heart disease ratio in the first aid vehicle group, The National Institutes of Health Stroke scale (NIHSS) score was higher than that in the non-ambulance group [(65 卤11) years old vs (61 卤11) years old: 15.9% (14 / 88) vs 5.6% (9 / 160) 9 (3 / 160) score: 2 (1 / 5)], and the stroke rate was lower than that in the non-first-aid vehicle group [23.9% (21 / 88) vs 37.5% (60 / 160)], and there was significant difference between the two groups (P0.05). There were significant differences in self-judgment and self-care awareness between the first aid vehicle group and the non-first aid vehicle group (P0.01). (3). In the first aid vehicle group, the time from onset to hospital and from hospital to evaluation was shorter than that of CT examination [102 (64150) min vs 136 (86230) min ~ 3 (1 / 8) min vs 7 (411) min ~ 15 (1823) min vs 16 (22 ~ 27) min, (41 卤9) min vs (50 卤10) minutes, P0.05]. The older (OR1.04 / 95CIV 1.01C: 1.08P0.01) has a high score of NIHSS (OR1.1395CIW 1.081.19P0.01), the patient or informant judges the state of emergency (OR17.0895 CIV 5.785.781P0.01), the patient is more likely to be transported to the hospital through an emergency cart (Or38.1395 CIU 10.131395 CI 10.133.61P0.01), and the acute stroke patients who take their own medicine (OR6.82CI2.339.9P0.01) are more likely to be transported to the hospital through the ambulance. Conclusion the use of emergency vehicle can reduce the delay of treatment in patients with acute stroke, and it is easier for those with self-care consciousness to choose first aid vehicle. Education on the importance of using emergency vehicles should be strengthened for stroke patients.
【作者单位】：首都医科大学卫生管理与教育学院;首都医科大学宣武医院神经内科;北京急救中心中区分中心;东营市第二人民医院神经内科;首都医科大学宣武医院神经外科;
【基金】：国家自然科学基金资助项目(81325007)
【分类号】：R743.3

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