脑梗死患者就诊延迟的影响因素分析

目的分析影响脑梗死患者急性期就诊延迟的相关因素,从而寻找可能的解决办法。方法采用问卷调查的方法,随机选取2011-06—2012-11来院就诊的182例急性脑梗死患者,对患者及家属进行问卷调查,详细记录患者发病时间及就诊过程,采用卡方检验和Logistic回归模型分析就诊延迟的相关因素。结果全部脑梗死患者均经头颅CT/MTR证实,对病情不重视、对卒中知识不了解以及抵院方式、首次就诊医院等有关。结论导致急性脑梗死患者就诊延迟的相关因素很多,其中最重要原因是患者对脑梗死早期诊治认识不足,加强公众脑卒中相关医学知识教育,对减少这些因素的影响将具有重要意义。     

急性脑卒中早期康复治疗的临床观察

1资料与方法1.1一般资料2000年1月～2004年12月入住本院神经内科的急性脑卒中患者共156例,均符合1995年全国第四次脑血管会议制定的诊断标准,并经头颅CT证实,且均首次发病伴肢体功能障碍,其中男86例,女70例,脑梗死91例,脑出血65例,随机分为康复组和对照组各78例,2组病情具有可比性(P>0.05)。1.2方法2组患者急性期均给予常规药物治疗,康复组于生命体征稳定,Glasgow≥9分后开始康复治疗,包括保持正确肢位、瘫痪肢体被动运动,、主动运动训练、坐位平衡、站立平衡训练、移动训练、认知及日常生活能力训练等。1.3疗效评定治疗前1d和治疗30d后2…     

进展性缺血性脑卒中相关因素的研究进展

进展性缺血性脑卒中是指起病6h后,虽经过临床治疗在1周内病情仍在进行性加重的卒中,其发生率为脑卒中患者的30％左右,没有明确的药物可以阻止进展性脑卒中的病程,其致残率、病死率均高于其他类型的脑梗死。脑梗死患者一旦出现进展性卒中,临床医生、患者和家属均感到失望。本文围绕进展性缺血性脑卒中的相关因素,综述如下。     

脑卒中对患者生活质量影响的分析

为了解脑卒中对患者的危害及生活质量的影响,回顾性地分析了自1972年～1998年宣武医院就诊的12679例脑血管病例资料,针对脑血管病友病次数、病残及死亡情况进行分析研究。本资料显示脑卒中的复发比例达53．6％,死亡比例为12.7%,76.2％的患者遗留残疾,其中使患者丧失劳动能力、影响其生活质量的中、重度病残比例达61.5％,说明脑卒中是严重影响人类的生活质量及生命的疾病,     

提高急性脑卒中诊治水平

20多年前我们对卒中的诊断主要依靠临床表现和脑脊液检查鉴别脑出血和脑梗死。随着现代影像学、病因学和临床工作的发展,已经认识到它们不是一个独立的疾病,而是一组临床综合征。无论脑梗死还是脑出血,脑动脉硬化均是它们主要的病因。血液成分改变、血管内皮改变、血管壁改变、     

老年脑卒中住院患者肺部感染的危险因素分析

目的分析老年脑卒中住院患者肺部感染的危险因素及应对策略。方法将2010-07—2011-06我院神经内科收治的86例老年脑卒中患者根据是否发生肺部感染情况分为肺部感染组(43例)与对照组(43例),回顾性分析2组患者的临床资料,总结老年患者发生肺部感染的危险因素。结果分析比较肺部感染组与对照组患者在意识状态、卧床时间、基础疾病、饮食状况等方面的差异,结果显示意识障碍或昏迷、卧床>1周、伴糖尿病、伴COPD、鼻饲饮食是神经内科老年住院患者发生肺部感染的危险因素。结论针对神经内科老年住院患者发生肺部感染的危险因素进行有效全面的护理,减少细菌存留的时间与数量,防止老年患者发生误吸现象,对有效预防肺部感染的发生具有重要作用。     

脑卒中患者康复护理的效果

目的探讨脑卒中患者康复护理的效果。方法选取脑卒中患者110例,采用随机数表法随机分为2组A2组(对照组)55例行常规护理,A1组(观察组)55例在常规护理基础上实施康复护理。对比2组在日常生活能力恢复情况以及运动能力恢复情况的差异。结果 A1组日常生活能力恢复及运动能力恢复方面均优于A2组,差异有统计学意义(P0.05)。结论康复护理干预能够有效恢复脑卒中患者的神经功能,降低临床致残率,显著提高脑卒中患者的生活质量。     

急性脑血管病患者就诊时间及延迟因素调查分析

目的调查急性脑血管病发病后-到达医院就诊的时间,分析导致延迟就诊的相关因素。方法前瞻性调查516例急性脑血管病人发病-就诊治疗时间,并做脑血管病知识调查,对超过5 h的延迟病例做原因分析。结果发病后3 h内到达者69例(13.37%),3~6 h 61例(11.82%),6~72 h 205例(39.73%),72 h~7 d 181例(35.08%),分析认为:发病时未接触任何人、未使用急救车转运、首诊医院、患者对脑血管病症状的认识缺乏、脑血管病类型、发病地点与医院间距离远、与到院时间延迟最为相关(P<0.05或P<0.01),文化程度、发病时间、经济状况也与到院时间有关。结论急性脑血管病人发病后到院明显延迟,需加强公众对急性脑血管病症状及早期治疗重要性的认识,提高公众对急性脑血管病发病后的求救意识。     

急性脑卒中发病时间分析

目的 分析急性脑卒中发病的时间.方法 统计2675例急性脑卒中患者(脑梗死组1925例,脑出血组750例)的发病时间,从0:00开始,按每2 h为1时段进行分组,对各时段病例数进行分析.结果 脑卒中患者发病时间分布与血压24 h昼夜节律相似呈双峰曲线,(1)脑梗死组发病时间分布第1峰在6:00～10:00,第2峰在18:00～22:00.且第1峰值明显高于第2峰值(P<0.01);(2)脑出血组发病时段分布与脑梗死组相似,但第2峰值明显高于第1峰值(P<0.05).结论 脑卒中发病时间与昼夜血压生理节律变化有一定关系,6:00～10:00和18:00～22:00为高峰时段.     

脑卒中预后的影响因素分析

目的探讨影响脑卒中患者3个月预后的相关危险因素。方法以首发脑卒中住院的急性患者为研究对象，记录其人口特征，脑卒中危险因素，最初脑卒中严重性如眼球运动障碍、失语、吞咽困难、尿失禁(UI)、格拉斯哥昏迷评分(GCS），神经功能缺损评分(NIHSS)，日常生活能力评分(BI）及脑卒中类型；3月后随访其功能康复情况：牛津残障评分(OHS）．并分析影响脑卒中预后的相关危险因素。结果Logistic回归分析发现：GCS，UI和NIHSS独立地与脑卒中后3个月预后不良显著相关。结论脑卒中急性期尿失禁、GCS评分高及神经功能缺损严重是脑卒中后3个月死亡或严重残疾的独立预测指标。     

Sources and reasons for delays in the care of acute stroke patients

OBJECTIVE: This study aimed to identify sources and reasons for delays in the care of our acute stroke patients. METHODS: Data on time interval from symptom onset or awareness to initial presentation, to neurology assessment, to performance of cranial CT scan, and demographic and medical factors associated with delays among stroke patients admitted at St. Luke's Medical Center from May to October 2000 were obtained by interview and record review. RESULTS: Of 259 patients (mean age 61.5+/-13.6 years, 43% females), 63% had infarction (INF), 32% intracerebral hemorrhage (ICH) and 5% subarachnoid hemorrhage (SAH). Fifty-nine percent presented within 3 h of symptom onset or awareness, 73% within 6 h (median=2 h). Patients with ICH presented earlier than those with infarction. Reasons for delayed consultation included failure to recognize symptoms as serious and stroke-related. A non-neurologist was initially consulted in 97% of cases. Median delay from presentation to neurology evaluation was 7.5 h. Median time from presentation to brain imaging was significantly shorter for patients brought to CT-equipped facilities (2 h) than for those needing transfer to other hospitals (11.5 h). CONCLUSIONS AND RECOMMENDATIONS: Patient delay in presentation is only one cause of delay in acute stroke care. Longer delays arise from healthcare-related factors such as delays in neurologist referral and neuroradiologic diagnosis. Professional and public education on the necessity of early neurologic evaluation and patient transport to CT-equipped "Stroke Centers" is recommended.     

早期就诊的急性缺血性卒中病人未溶栓原因分析

目的:研究6小时内到达医院就诊的急性缺血性脑卒中未进行溶栓治疗的原因。方法:通过对实施急性脑血管病急诊绿色通道1年期间,发病6小时内就诊的患者未进行溶栓治疗的原因进行分析。结果:166例缺血性脑卒中患者在发病6小时内经急诊绿色通道就诊,81例符合溶栓条件的患者中47例接受溶栓治疗,占符合溶栓条件患者28.31%。溶栓患者平均发病时间(211.70±86.10)min,NIHSS评分10(范围5～22)。静脉溶栓25例,动脉溶栓22例。从发病至静脉溶栓平均开始时间为(55.48±26.01)min,明显短于动脉溶栓平均开始时间(86.59±40.40)min(P=0.003)。119例未进行溶栓治疗患者中不符合条件85例,符合条件而未溶34例(占20.48%)。发病6小时内就诊的患者未溶栓的原因有神经功能障碍轻或明显改善、早期显示病灶、脑栓塞以及家属或患者拒绝。结论:发病6小时内就诊的患者未进行溶栓的可调整原因主要是家属或患者拒绝。加强公众对脑卒中的了解及接受程度有助于提高溶栓比例。     

脑卒中再入院的原因及其危险因素分析

目的探讨脑卒中患者出院后的再入院风险及其危险因素。方法患者样本来源于2009年01月01日至2011年06月30日南京脑科医院,急性脑卒中入院患者。对所有患者,进行入院原因调查与出院后再入院随访。主要再入院原因被分类为：脑卒中再发、神经系统后遗症、心血管事件、感染及其他原因。采用Kaplan—Meier生存分析评估患者再入院的风险,COX比例危险模型评估患者第一次再入院的危险因素。结果总计有效病例为529例,最长随访天数为1282d。随访中再入院患者为210例。通过Kaplan—Meier生存曲线分析表明,再入院风险在30d为6．8％,在90d为12．7％,在180d为18．9％,在360d为27．8％,720d为39．9％。最常见的再入院原因为脑卒中再发,神经系统后遗症,心血管事件等。在COX比例危险模型中,脑卒中病史（P=0．04）,急性感染史（P=0．02）,血脂异常史（P=0．04）以及低密度脂蛋白胆固醇（LDL—C）（P=0．00）,以上因素对患者再入院的影响,具有统计学意义。结论脑卒中患者在出院后再入院的几率非常高,脑卒中复发和各种并发症成为最为重要的原因。容易忽视或不易戒除的因素,如血脂,吸烟等,对患者再入院有一定的提示作用。     

Analysis of the reasons for exclusion from tPA therapy after early arrival in acute stroke patients

OBJECTIVE: Only a small percentage of patients with acute stroke receive thrombolytic therapy, mainly due to late hospital arrival. Factors excluding those who arrive within 3h after stroke onset are less well known. PATIENTS AND METHODS: During the first year after implementing a protocol for stroke thrombolysis, we prospectively evaluated all patients with stroke admitted to our center within 3h from onset. Within-hospital time intervals were calculated and the reasons for exclusion from thrombolysis were analyzed. RESULTS: Ninety-six patients (representing 16% of all stroke patients admitted) arrived in less than 3h, and 25 of them (representing 7.5% of all patients with ischemic stroke) received thrombolytic therapy, with a door-to-needle interval of 51 min (range, 33-121). The reasons that accounted for 75% of therapy exclusions were non-modifiable (a too mild or improving deficit, and intracranial hemorrhage), except for a time window exceeded, which would probably require increasing public awareness about stroke. CONCLUSIONS: Most reasons for not applying thrombolysis to patients who arrive early enough are non-modifiable. Minimizing the door-to-needle time could compensate for late hospital arrival, which continues to be the main reason for not applying this therapy to stroke patients throughout the world.     

Prehospital and in-hospital delays in acute stroke care

Current guidelines emphasize the need for early stroke care. However, significant delays occur during both the prehospital and in-hospital phases of care, making many patients ineligible for stroke therapies. The purpose of this study was to systematically review and summarize the existing scientific literature reporting prehospital and in-hospital stroke delay times in order to assist future delivery of effective interventions to reduce delay time and to raise several key issues which future studies should consider. A comprehensive search was performed to find all published journal articles which reported on the prehospital or in-hospital delay time for stroke, including intervention studies. Since 1981, at least 48 unique reports of prehospital delay time for patients with stroke, transient ischemic attack, or stroke-like symptoms were published from 17 different countries. In the majority of studies which reported median delay times, the median time from symptom onset to arrival in the emergency department was between 3 and 6 h. The in-hospital times from emergency department arrival to being seen by an emergency department physician, initiation and interpretation of a computed tomography (CT) scan, and being seen by a neurologist were consistently longer than recommended. However, prehospital delay comprised the majority of time from symptom onset to potential treatment. Definitions and methodologies differed across studies, making direct comparisons difficult. This review suggests that the majority of stroke patients are unlikely to arrive at the emergency department and receive a diagnostic evaluation in under 3 h. Further studies of stroke delay and corresponding interventions are needed, with careful attention to definitions and methodologies.     

Impact of acute stroke team emergency calls on in-hospital delays in acute stroke care.

INTRODUCTION: Acute stroke is a medical emergency. Therefore, early recognition and rapid activation of the medical system are important prerequisites for successful management. We sought to investigate the impact of our new Acute Stroke Team emergency call system (AST) on admission delays from the emergency department (ED) to the stroke care unit (SCU) and on the subsequent length of stay (LOS) and in-hospital mortality. METHODS: We retrospectively analysed data obtained from the Austin Hospital stroke unit database and the electronic medical record/patient tracking system for the 5 months before (August to December 2004) and after (January to May 2005) the introduction of the AST. RESULTS: Data for 352 patients were extracted. Of these, there were 260 (73.9%) patients with ischaemic stroke, 38 (10.8%) with intracerebral haemorrhage and 54 (15.3%) with transient ischaemic attack (TIA). One hundred and seventy-two patients were admitted before and 180 after AST introduction. There were 70 AST calls from January to May 2005. Baseline characteristics of both groups were similar. Between the two groups, the median (Q1,Q3) time from door to CT scan was significantly reduced from 104 (60,149) to 82 (40,132) minutes. The LOS was significantly reduced from 6 (3,9) to 3 (2,7) days. There was no significant impact on mortality. CONCLUSION: The introduction of AST has reduced the time from door to brain CT scan. This is an important finding as the window period for thrombolysis is short and early diagnosis is crucial.     

Regional disparities in acute and post-acute care of stroke patients in France, 2015

Objective

The aim of this study was to assess regional variations of the hospital management of stroke patients during acute and post-acute phases in France in 2015.

Acute stroke care in France: Survey in the 138 stroke units

BackgroundAccording to the French regulation, stroke units (SU) include both an intensive (I-SU) and a non-intensive (NI-SU) component. Their standard operating procedures have been detailed in governmental directives in 2003 and 2007.ObjectivesTo evaluate (i) resources available in French SU, (ii) differences between regions, and between France and the 2 close European countries of similar size, and (iii) to identify avenues for improvement.MethodsWe performed a survey of all French SU, with an online questionnaire, to evaluate available resources and activity. We compared the 17 French regions, and France, with Germany and Italy. We used 2019 as year of reference.ResultsThe 138 French SU, shared 911 I-SU beds; 123 SU (89.1%) answered the questionnaire. The number of I-SU beds per million inhabitants was 13.6 for the whole country, with important differences between regions, ranging from 7.0 (Reunion Island) to 20.9 (Occitanie region). Per million inhabitants, France had fewer I-SU beds than Germany and Italy (13.5 vs. 29.9 and 23.2 respectively), and fewer thrombectomy centres (0.6 vs. 1.8 and 1.0). Per million inhabitants, France had also lower thrombolysis (203 vs. 402) and thrombectomy (104 vs. 194) rates than Germany, but, compared with Italy, similar thrombolysis rates (203 vs. 202) and higher thrombectomy rates (104 vs. 81).ConclusionThere are still avenues for improvement in acute stroke care in France, especially concerning the number and regional repartition of I-SU beds, and access to reperfusion therapies.