规范治疗急性脑卒中显著降低患者住院病死率

目的　制定卒中规范治疗方案并观察其在实际操作中对降低卒中病死率的效果。方法　采用多中心病例历史对照。根据循证资料,结合国情,由专家制定急性脑梗死和脑出血规范诊断和治疗方案,内容包括建立卒中单元方案、诊断方案、发病不同时间段治疗方案以及康复和护理方案等。收集全国 30家医院 2002年 7月至 2003年 5月间首次发病 7d内的脑梗死或者脑出血患者,根据预定的统一方案(见附录)进行诊治。以各单位 2001年全年同条件的脑梗死或脑出血患者为对照。两组均随诊 6个月,比较住院期间和随诊 6个月的病死率差别。结果　对照组收集 6967例,治疗组 1115例。与对照组比较,规范治疗明显降低患者的并发症,尤以呼吸道感染率降低比较明显,其中气管插管减少 79 1%, 气管切开减少 80 0%。住院期间患者病死率治疗组为 3 8%, 对照组为10 7%,两组比较差异有统计学意义(P<0 01)。长期效果更为明显, 6个月时患者病死率在治疗组为 0 5%, 对照组 7 1% (P<0 01)。结论　急性脑卒中患者的规范治疗可以降低患者住院期间和短期的病死率。

Standardized diagnosis and management in reducing fatality rate of patients hospitalized with acute stroke

Objective To establish a guideline of acute stroke diagnosis and management, as to evaluating its effects on outcome of acute stroke.Methods A trail of multiple center study was carried out. Thirty hospitals, covering county, city or national hospitals from richer or poorer regions, participated the study.Basing on the guideline, all the physicians provided from their center, which included the schemes of stroke units, diagnosis, management, nursing and rehabilitation. The data before assessment of the guideline in the year 2001 were used as control, and the data after assessment of the guideline in 2002 and 2003 were defined as study group. The end points were death rate in discharge from hospital and in 6 months after attack .Results Totally, 6967 cases were enrolled in the control group, and 1115 cases in the study group. Complications of acute stroke were significantly decreased in the study group (from 27.8% to 24.0%). The reduction of severe pulmonary infection was reduced more obviously. The tracheal incubation reduced in 79.1%, and tracheotomy reduced in 80.0%. Rehabilitation started earlier and more frequently. The improvement of management resulting in hospital fatality of acute stroke was decreased. The death rate was 3.8% in study group, while 10.7% in the control during the hospitalization. In following-up for 6 months, the death rate was 0.5% in study group and 7.1% in the control.Conclusion Standardization in the diagnosis and management of acute stroke might significantly reduce the death rate in period of hospitalization and in 6 months of acute stroke.