湖南地区三类不同级别医院蛛网膜下腔出血诊疗现状调查

发布时间：2019-07-03 14:22

【摘要】：目的：本研究通过回顾性分析考察湖南地区三类不同级别医院(一级、二级、三级)蛛网膜下腔出血(SAH)患者在诊断技术的应用、治疗路径的选择和近期预后等的差异,为我国制订蛛网膜下腔出血实用的、规范化的诊疗技术与流程,以及为政府卫生资源的投入决策提供参考。方法：采用回顾性分析对2009年1月--2012年7月期间,来自湖南省、区(县)、乡(镇)三类不同级别医院(一级、二级与三级医院共5家医院)总共399例蛛网膜下腔出血(SAH)患者的病史资料、实验室资料、病因学、症状学、诊断技术的应用、治疗路径的选择、以及近期预后进行调查分析,并进行统计学处理。结果：1、人口学资料：三类不同级别(一级、二级、三级)医院蛛网膜下腔出血(SAH)患者在性别、年龄、身高、体重、体重指数等人口学资料比较无统计学意义(P0.05)。2、既往疾病史资料：在脑卒中史、冠心病史、糖尿病史、高血压病史、脑血管病家族史、服用抗血小板药物等比较,无统计学差异意义(P0.05)。但三类不同级别医院蛛网膜下腔出血(SAH)患者的吸烟史和饮酒史相互比较有统计学差异(P0.05)。二级医院蛛网膜下腔出血(SAH)患者吸烟史比例明显高于一、三级医院,一级医院蛛网膜下腔出血(SAH)患者饮酒史比例明显高于二、三级医院。3、症状学资料：399例患者中各种首发症状的比例为：头痛(81.7%)、意识障碍(6.5%)、抽搐(3.8%)、头晕(2.5%)、枕颈部胀痛(1.8%)、其它表现(3.8%)。经统计学分析,一级、二级、三级中的SAH症状学比较无统计学意义(P0.05)。4、诊断技术的应用：三类不同级别医院均应用CT扫描诊断SAH,但发病后24小时内,一、二、三级医院应用CT检查SAH使用率分别为：17.8%、27.5%、42.7%,经统计学比较,有显著性差异。其他三个时间点(48、72、96小时)无统计学差异。应用腰椎穿刺诊断SAH,一级医院均未做此项检查、二级与三级医院应用率也较低(小于5%),未行统计学处理。5、病因学调查：三类医院中,一级医院未能做SAH出血的病因学检查,二级医院120例蛛网膜下腔出血患者52例行CTA检查28例发现动脉瘤(23.3%)。三级医院165例完成CTA(92.7%)、95例完成的DSA(53.4%),共发现动脉瘤124例(69.4%),动-静脉畸形24例(13.4%),其他病因30例(16.8%)。6、治疗路径：一、二级医院均行内科治疗；三级医院行动脉瘤夹闭手术96例(53.9%),介入填塞47例(26.4%),内科治疗35例(19.7%)。7、近期预后：一、二、三级医院1个月内的病死率分别19.8%、23.8%、6.8%;一、二、三级医院预后良好者分别36.6%、41.7%、69.1%；二项指标经统计学处理有显著性差异(P0.05)。而且三级医院的不同治疗途径近期预后相比,差异有统计学意义(P0.05)。结论：湖南地区三类不同级别医院在蛛网膜下腔出血(SAH)的诊断技术应用、治疗路径的选择、近期预后等方面存在明显的差别。及早确立SAH诊断,及早查明出血病因,同时及早处理病变血管(结扎或填塞),这“三个及早”是改善SAH近期预后的关键,我国现阶段三类不同级别医院均存在较大的提升空间,在一、二级医院尤其突出。
[Abstract]:Objective: To study the difference of the application of three different grade hospitals (primary, secondary, tertiary) and subarachnoid hemorrhage (SAH) in the area of Hunan, and the selection of the treatment route and the short-term prognosis. In order to develop a practical and standardized diagnosis and treatment technology and process for subarachnoid hemorrhage in China, and to provide reference for the investment decision-making of government health resources. Methods: A total of 399 cases of subarachnoid hemorrhage (SAH) in a total of 399 cases of subarachnoid hemorrhage (SAH) were collected from a total of 399 cases of subarachnoid hemorrhage (SAH) during the period from January 2009 to July,2012 by a retrospective analysis. The application of materials, laboratory data, etiology, symptoms, diagnostic techniques, the selection of treatment routes, and the short-term prognosis are investigated and analyzed, and a statistical office The results were as follows:1. Demographic data: There is no significant difference between the data of the three categories (primary, secondary and tertiary) of the subarachnoid hemorrhage (SAH) in the three categories: sex, age, height, body weight and body weight index (P0.05). History of stroke, history of coronary heart disease, history of diabetes, history of hypertension, family history of cerebrovascular disease, and antiplatelet drugs. There were significant differences in the history of smoking and the history of alcohol consumption among the three types of SAH patients (P0. 05) The proportion of the smoking history of the patients with subarachnoid hemorrhage (SAH) in the secondary hospital is significantly higher than that of the first and third-level hospitals, and the proportion of the drinking history of the patients with subarachnoid hemorrhage (SAH) in the first-order hospital is significantly higher than that of the second and third-level hospitals. The ratio was: headache (81.7%), consciousness disorder (6.5%), twitch (3.8%), dizziness (2.5%), pillow neck pain (1.8%), and other performance (3. The results of statistical analysis, primary, secondary, and tertiary SAH symptoms were not statistically significant (P0.05).4. The application of the diagnostic technique: CT scan was used to diagnose SAH in three types of hospitals, but within 24 hours after the onset, the use of CT in one, two, and three-level hospitals was used to check the utilization rate of SAH. The results were: 17.8%, 27.5% and 42.7%, respectively. Sex differences. No statistics for the other three time points (48,72,96 hours) To study the difference, the application rate of the secondary and tertiary hospitals was lower (less than 5%), and no statistical treatment was performed.5. The etiology of the disease: the first-level hospital did not have the cause of SAH bleeding. In the second-stage hospital,52 cases of subarachnoid hemorrhage were examined by CTA and 28 cases were found (23). A total of 165 cases of three-level hospitals (92.7%) and 95 completed DSA (53.4%) were found,124 (69.4%) of the aneurysms,24 (13.4%) of the dynamic-venous malformations,30 (16.8%) of the other causes,6, the treatment route: one and two secondary hospitals for internal medical treatment, and 96 (53) cases of aneurysm clipping in the third-level hospital. In the first, second and third hospitals, the mortality was 19.8%, 23.8% and 6.8%, respectively. The prognosis in the first, second and third-level hospitals was 36.6%, 41.7%,69%, respectively. There was significant difference between the two indexes (P> 0.05). 05) There is a significant difference in the short-term prognosis of different treatment routes of the three-level hospital (P0. 05). Conclusion: There are three types of hospital in Hunan area in the diagnosis of subarachnoid hemorrhage (SAH), the choice of treatment route, the short-term prognosis and so on. Obvious difference. Early establishment of SAH diagnosis, early identification of the cause of the bleeding, and early treatment of the pathological vessel (ligation or packing), the "three early" is the key to improve the short-term prognosis of SAH. At present, there is a large lifting space in three types of hospitals in our country, in one and two-level medical treatment.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.35

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