鄂尔多斯地区脑梗死院前患者延误的影响因素

目的探讨鄂尔多斯地区脑梗死(CI)患者院前延误的特征和影响因素。方法前瞻性连续登记2012年1月1日至2015年12月31日期间因CI入院的患者,采用问卷和访视调查方法调查院前延误(从卒中症状出现至做出就医决定)和运送所需时间(从做出就医决定至到达医院),记录卒中现场情况、认识行为和社会人口学变量等,采用单变量和多变量分析方法研究院前延误的影响因素。结果纳入490例,其中147例(30%)发病2h内做出就医决定(早期就医决定组),343例(70%)发病2 h后做出就医决定(延误决定就医组)。NIHSS评分、Barthel指数、以意识障碍起病、既往因脑卒中曾住院治疗、发病现场认识到卒中、发病现场有家属或同事、症状进行性加重、患者或家属或同事知晓溶栓治疗对院前时间差异有统计学意义。是否使用120救护车对院前时间有显著性影响。多变量Logistic回归分析显示,发病时有家属或同事或既往因脑卒中曾住院治疗是促进早期决定就医的独立影响因素,而症状较轻或夜间发病是造成就医定延误的独立影响因素。结论就医决定延误是本地区CI院前延误的主要原因,家属或同事或既往因脑中曾住院是减少决定延误的重要因素,普及本地区居民卒中知识、增加使用救护车及改善本地区医院布可能使更多脑梗死患者获益。     

中国七城市卒中患者急诊溶栓情况分析

目的 超早期重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator,rt-PA）溶栓治疗是缺血性卒中有效的治疗方法,但目前缺血性卒中救治过程中存在溶栓率偏低的问题,本调查的目的在于了解实际溶栓状况及未溶栓原因。方法 本调查在中国的7个城市31家中心展开前瞻性调查,调查采用标准的登记数据,内容包括患者的一般人口学信息、院前卒中急救信息、院前院内关键延误时间、溶栓信息等。结果 在研究期间,共有1091例患者确诊符合入选标准,其中754例（69.6%）急性缺血性卒中患者中共有20例（2.7%）患者溶栓,其中静脉rt-PA15例、动脉rt-PA2例、静脉尿激酶（Urokinase,UK）3例。在静脉rt-PA中,93.3%（14/15）存在方案违背。大部分病例（17/20）在2 h内就到达了医院,院前延迟平均中位时间为1.17 h。急诊接诊到获得检查（CT或磁共振）平均中位时间为0.67 h。未进行溶栓的主要原因除年龄（>80岁或<18岁）（28.9%）、卒中症状太轻（24.0%）、病情迅速恢复（16.5%）、CT影像已有病灶（15.7%）、时间>3 h（15.7%）、卒中症状太重（7.4%）等因素外,患者/家属主观拒绝仍占了18.2%。结论 急性缺血性卒中溶栓比例偏低,溶栓药物使用不规范且存在方案违背,存在院前延迟问题,亟待整合院前急救中心与医院间医疗资源,规范院前转运途径,缩短延误时间,提高溶栓率。     

急性脑卒中患者就医时间的观察及相关因素分析

为了了解急性脑卒中就医时间（从起病到影像学确诊后开始治疗时间），联合江苏省苏南、苏北四家医院，对320例急性脑卒中患者就医时间观察分析。结果：患者就医时间以江苏省人民医院最短，南京市第一医院次之，徐州铁路中心医院第三，兴化市第一医院第四。320例患者6小时内就医者仅占20%，且缺血性卒中6小时内就医者不足15％；患者文化程度高低与其就医时间呈负相关。结论：江苏地区急性缺血性脑卒中患者有85％失去了起早期治疗机会，主要原因是由于患者送诊医院内外的延误。进行广泛社区科普教育，建立社区急救网络，加强院内急救“绿色通道”，是开展趁早期治疗的前提。     

建立中国急性缺血性卒中溶栓医疗质量持续改进体系

卒中是我国居民死亡的第一位杀手,也是成人致残的第一位原因。国内外发表的急性缺血性卒中临床指南均强调在时间窗内给予静脉重组组织型纤溶酶原激活剂(recombinanttissue plasminogen activator,rt-PA)溶栓是最有效的治疗方式,但由于溶栓意识匮乏、院前或院内延误等原因,许多急性缺血性卒中患者得不到rt-PA治疗或无法获得规范的溶栓治疗。对于急性缺血性卒中患者来说,在卒中症状发生后越早使用rt-PA溶栓治疗,其恢复良好神经功能的可能性越大(图1)。Lansberg     

急性缺血性卒中院前延误现状和改进措施的研究进展

我国急性缺血性卒中发病率高,院前延误形势严峻,疾病救治负担重。但相关影响因素及可采取的措施还不甚清楚或存在矛盾的报道,这不利于政府部门的决策制定。本综述发现受教育程度低、卒中发作时独处或独居、新型冠状病毒感染疫情、位于农村者易引起院前延误,而有高血压、TIA和缺血性卒中既往史以及构音障碍、肌力下降、前循环卒中、经救护车转运的患者院前延误较少。加强卒中宣传和教育、建设移动卒中单元和提高信息化水平是缩短院前延误的有效措施。这些研究发现可以为进一步减少院前延误,提高急救效率,辅助政府决策制定提供参考依据。     

肾小球滤过率与急性缺血性卒中关系研究

目的 探讨肾小球滤过率对急性缺血性卒中发病、严重程度及患者认知功能的影响.方法 回顾性分析2018年8月-2019年10月就诊于大连市友谊医院神经内科的急性缺血性卒中患者的临床资料,以同期入院的非卒中且无卒中病史患者为对照组,对两组的基线资料进行单因素和多因素分析,判断缺血性卒中的独立影响因素.另外,缺血性卒中组按照估...     

鄂尔多斯地区脑梗死患者院前时间的研究

目的探讨鄂尔多斯地区脑梗死患者院前时间和影响因素。方法前瞻性连续登记2012年1月1日至2014年5月31日期间因脑梗死入院的患者,采用问卷和访视调查方法调查院前时间及相关因素。结果共纳入320例脑梗死患者,其中24例(7.5%)症状出现后2 h内到达医院,92例(28.75%)发病2 h内做出就医决定(早期就医决定组),228例(71.25%)发病2 h后做出就医决定(延误决定就医组),早期决定就医对院前时间影响有统计学意义(P0.001),但两组转送时间差异无统计学意义(P=0.924),是否使用120救护车对院前时间影响有统计学意义(P0.001),发病时是否求助诊所医师对院前时间影响无统计学意义(P=0.182)。结论本地区脑梗死院前延误非常严重,就医决定延误是主要原因,不能充分利用救护车也是重要原因,普及本地区居民卒中知识、提倡使用救护车及改善医院布局可使脑梗死患者获益。     

“互联网+”在急性缺血性卒中救治中的应用进展

随着“互联网+”时代的到来，互联网技术在全球卫生系统的应用增加，其在急性缺血性卒中救治中的应用也得到相应发展。基于互联网信息技术，应用手机等终端设备应用程序，使急性缺血性卒中救治更加的高效、便捷、实用，但应重视应用过程中的伦理学问题。本研究对“互联网+”在急性缺血性卒中院前急救、院前院内衔接、院内绿色通道中的应用进行综述，为构建“互联网+”卒中救治新模式提供帮助。     

缺血性卒中静脉溶栓预后预测的研究进展

静脉溶栓是急性缺血性卒中最有效的治疗方法,但同时伴随着出血转化及预后不良风险 的增加。本文对急性缺血性卒中静脉溶栓预后不良的危险因素及相关预测模型进行综述,对不同预 后预测模型的特点及预测能力进行分析比较,以期帮助临床神经科医师在接诊急性缺血性卒中患者 时对于是否行静脉溶栓进行快速评判并指导决策。     

编者按

正经过25年的发展,缺血性卒中静脉溶栓取得了巨大的进步。但急性缺血性卒中的溶栓率在全球范围内依然很低。除了卒中教育、建立区域卒中救治系统、建立有效的院前流程、建立院内卒中团队、实施持续医疗质量改进外,如何从急性缺血性卒中人群中筛选出更多有可能从溶栓中获益的患者,是各国学者努力的方向。有几个重要问题亟待临床研究的验证和突破:第一,超出4.5 h溶栓。有研究     

Knowledge about stroke in patients admitted in a French Stroke Unit

Admission delay remains the main cause for stroke patient exclusion from urgent therapeutic protocols. Public lack of knowledge about stroke symptoms may result in delay in seeking medical care and late presentation at hospital. Lack of knowledge of risk factors for stroke may also hamper compliance with stroke prevention practices. The aim of this prospective study using a standardized questionnaire was to evaluate the stroke awareness of acute stroke patients in France. From July 2, 1998 to July 2, 1999, 166 consecutive stroke patients were admitted at our stroke unit. Among the 91 patients who were able to answer the questionnaire during the first 48 hours, only 19 patients (21 p.cent) thought they were having a stroke before their arrival at the hospital, 38 patients (42 p.cent) did not know a single sign of stroke and 33 patients (36 p.cent) did not know a single risk factor of stroke. The most common risk factors named by the patients were smoking and hypercholesterolemia (named by 31 patients (34 p.cent) and 19 patients (21 p.cent), respectively). The most common warning signs named by the patients were paralysis of one side of body or one limb and speech disturbance (named by 40 patients (44 p.cent) and 15 patients (16 p.cent), respectively). Female sex and "knowing somebody who had a stroke" were significantly associated with awareness of signs of stroke in multivariate analysis. Educational public programs regarding stroke awareness are needed in France. Educational campaigns must stress the risk factors and symptoms of stroke and the appropriate response in the hopes of reducing admission delay and improving stroke prevention.     

Barriers to and facilitators for making emergency calls – a qualitative interview study of stroke patients and witnesses

Background and objectivesEarly access to hospital for diagnosis and treatment is strongly recommended for patients with acute stroke. Unfortunately, prehospital delay frequently occurs. The aim of the current study was to gain in-depth insight into patient experience and behavior in the prehospital phase of a stroke.MethodsWe conducted qualitative interviews with a purposive sample of 11 patients and six witnesses within four weeks post stroke. The interviews were audio recorded, transcribed, and analyzed utilizing Systematic Text Condensation.ResultsThe material was classified according to two main categories each containing three subgroups. The first category contained the diversity of sudden changes that all participants noticed. The subgroups were confusing functional changes, distinct bodily changes and witnesses’ observations of abnormal behavior or signs. The second category was delaying and facilitating factors. To trivialize or deny stroke symptoms, or having a high threshold for contacting emergency services, led to time delay. Factors facilitating early contact were severe stroke symptoms, awareness of the consequences of stroke or a witness standing by when the stroke occurred.ConclusionsPrehospital delays involved interrelated elements: (1) Difficulties in recognition of a stroke when symptoms were mild, odd and/or puzzling; (2) Recognition of a stroke or need for medical assistance were facilitated by interaction/communication; (3) High threshold for calling emergency medical services, except when symptoms were severe. The findings may be helpful in planning future public stroke campaigns and in education and training programs for health personnel.     

Stroke in Devon: knowledge was good, but action was poor

BACKGROUND AND AIM: Effective implementation of early treatment strategies for stroke requires prompt admission to hospital. There are several reasons for delayed admission. Good awareness should facilitate early admission. We identified local targets for education. METHODS: Four groups, each of 40 people, completed questionnaires to determine their knowledge of stroke symptoms and risk factors, and the action they took or would take in the event of a stroke. The groups were: patients with a diagnosis of stroke or TIA (within 48 hrs of admission); patients at risk of stroke; the general population; and nurses. RESULTS: Forty per cent of stroke patients identified their stroke. Median time from onset of symptoms to seeking medical help was 30 minutes. Medical help was sought by the patient themselves in only 15% of cases. In 80% of cases the GP was called rather than an ambulance. Of the at risk group, 93% were able to list at least one symptom of acute stroke, as were 88% of the general population. An ambulance would be called by 73% of the at risk group in the event of a stroke. Patients with self reported risk factors for stroke were largely unaware of their increased risk. Only 7.5% of at risk patients acquired their stroke information from the medical profession. CONCLUSIONS: Public knowledge about stroke is good. However, stroke patients access acute services poorly. At risk patients have limited awareness of their increased risk. A campaign should target people at risk, reinforcing the diagnosis of stroke and access to medical services.     

Inpatient and community ischemic strokes in a university hospital

BACKGROUND: Previous studies have shown that inpatient strokes are common and severe. We sought to characterize the risk factors, stroke subtypes, timing of acute stroke evaluation and frequency of thrombolytic therapy in inpatient ischemic strokes compared with community ischemic strokes. DESIGN/METHODS: The hospital records of patients admitted for acute ischemic stroke between 1996 and 2002 were reviewed. Acute stroke was defined as occurrence of stroke symptoms within 72 h, and in-hospital status was assigned if the patient was currently admitted for another illness at the time of the stroke. Patient demographics such as medical versus surgical service, admission diagnoses, clinical features including stroke risk factors, access to thrombolytic therapy and immediate outcome were analyzed. RESULTS: Of 947 patients with acute ischemic stroke, 161 (17.0%) had strokes occurring while already in the hospital (IHIS), compared to 786 (83%) that occurred in the outpatient community (CIS). Approximately two thirds of IHIS occurred on medical services (102, 63.4%) and one third on surgical services (59, 36.7%). Mean age, male gender, atherothrombotic etiology and risk factors including hypertension, diabetes and smoking history were of similar frequencies in IHIS and CIS, but penetrating artery disease was the cause of only 5.6% of IHIS compared to 21.8% of CIS (p<0.0001). The mean modified Rankin scale for IHIS at presentation was 4.33 +/- 0.74, compared to 3.67 +/- 1.03 for CIS (p<0.0001). Of 161 IHIS patients, 21 (13.0%) had neurological assessment within 3 h of symptom onset, compared to 16.0% of CIS patients (p=0.403, n.s.), and the rate of thrombolytic therapy was not significant between IHIS (3.7%) and CIS (5.6%) patients. CONCLUSIONS: IHIS are common and severer than CIS. The use of thrombolytic therapy in IHIS patients was limited because of time of recognition and inpatient-associated conditions. Increased vigilance for timely neurological assessment of these patients is warranted.     

院内急性缺血性卒中血管内介入治疗延误的影响因素分析

目的 分析院内急性缺血性卒中（acute ischemic stroke,AIS）患者血管内介入治疗延误的影响因素。 方法 回顾性纳入2014年10月-2019年7月于南京医科大学第一附属医院住院期间发生AIS并接受血 管内介入治疗的患者,根据发病至股动脉穿刺时间（onset-to-puncture time,OTP）是否超过120 min,将 患者分为延误组和非延误组。收集两组患者相关临床资料,观察两组预后情况,良好预后定义为 90 d mRS评分≤2分,采用多因素Logistic回归分析研究院内延误的影响因素。 结果 共纳入53例院内卒中患者,平均年龄64.43±12.46岁,男性29例（54.72%）。中位OTP为150 （115～200）min,其中延误组31例,非延误组22例。非延误组良好预后比例高于延误组（63.64% vs 35.48%,P =0.043）。多因素Logistic回归分析显示,发病后立即启动绿色通道（OR 0.061,95%CI 0.007～0.532,P =0.011）及高危科室发病（OR 0.108,95%CI 0.014～0.821;P =0.031）与院内卒中血管 内介入治疗延误呈独立负相关;而家属决策时间延长（OR 1.527,95%CI 1.114～2.094,P =0.008）与院 内卒中血管内介入治疗延误呈独立正相关。 结论 家属决策时间长是院内卒中血管内介入治疗延误的独立危险因素,发病后立即启动绿色通 道及高危科室发病是院内卒中血管内介入治疗延误的独立保护因素。     

Factors predicting choice of provider among homeless veterans with mental illness

OBJECTIVE: Homeless persons with serious mental illness are especially likely to lack access to comprehensive medical and psychiatric care. This study examined the relative importance of predisposing factors, illness factors, and enabling factors as determinants of the use of Veterans Affairs (VA) health care services by mentally ill homeless veterans seeking services from a non-VA program. Predisposing factors included demographic characteristics and wartime service; illness factors were related to the type of medical problem and the need to seek medical care; and enabling factors included entitlement to VA medical services and location of VA facilities. METHODS: Logistic regression analysis was used to analyze data for 698 homeless veterans with mental illness who were enrolled in the Access to Community Care and Effective Services and Supports (ACCESS) program. RESULTS: About 56 percent of the mentally ill homeless veterans had used VA services at some time in their lives. Homeless veterans were almost twice as likely as other poor veterans to use VA services; those with a dual diagnosis were also more likely to use VA services. Enabling factors were more important than either predisposing or illness factors in predicting VA service use. Veterans most likely to use VA services were those who received VA benefits that gave them priority access to VA services and those who lived near a VA medical center. CONCLUSIONS: Specific characteristics of the service system and of veterans' entitlement were more important than clinical needs or predisposing factors in predicting service use.     

院内急性缺血性卒中血管内介入治疗延误的影响因素分析

目的 分析院内急性缺血性卒中（acute ischemic stroke，AIS）患者血管内介入治疗延误的影响因素。
方法 回顾性纳入2014年10月-2019年7月于南京医科大学第一附属医院住院期间发生AIS并接受血
管内介入治疗的患者，根据发病至股动脉穿刺时间（onset-to-puncture time，OTP）是否超过120 min，将
患者分为延误组和非延误组。收集两组患者相关临床资料，观察两组预后情况，良好预后定义为
90 d mRS评分≤2分，采用多因素Logistic回归分析研究院内延误的影响因素。
结果 共纳入53例院内卒中患者，平均年龄64.43±12.46岁，男性29例（54.72%）。中位OTP为150
（115～200）min，其中延误组31例，非延误组22例。非延误组良好预后比例高于延误组（63.64%
vs 35.48%，P =0.043）。多因素Logistic回归分析显示，发病后立即启动绿色通道（OR 0.061，95%CI
0.007～0.532，P =0.011）及高危科室发病（OR 0.108，95%CI 0.014～0.821；P =0.031）与院内卒中血管
内介入治疗延误呈独立负相关；而家属决策时间延长（OR 1.527，95%CI 1.114～2.094，P =0.008）与院
内卒中血管内介入治疗延误呈独立正相关。
结论 家属决策时间长是院内卒中血管内介入治疗延误的独立危险因素，发病后立即启动绿色通
道及高危科室发病是院内卒中血管内介入治疗延误的独立保护因素。     

Patient recognition of and response to symptoms of TIA or stroke

BACKGROUND AND PURPOSE: Campaigns within Australia and internationally have sought to increase awareness of the emergent nature of stroke. For these initiatives to be effective it is important to gather information about delay in seeking treatment and the reasons given for the delay by people with stroke. The purpose of this study was to examine delay in seeking treatment in people with an evolving stroke or TIA and identify clinical, behavioral and demographic factors that contributed to the delay. SUBJECTS AND METHODS: During a 1-year period 150 participants were given the Response to Stroke Symptoms Questionnaire. The six domains included in the questionnaire were: (1) context in which the stroke occurred; (2) antecedents to symptoms; (3) affective response to symptoms; (4) behavioral response to symptoms; (5) cognitive response to symptoms; (6) the response of others to patient symptoms. RESULTS: The median delay time from symptom onset to admission to hospital was 4.5 h. While 41% of participants delayed less than 3 h, more than 45% delayed greater than 6 h. Independent predictors of delay time included mode of arrival at hospital with those taking an ambulance having a median delay time of 2.7 h vs. 15.4 h for those arriving by private car (p = 0.04). Gender also predicted delay with women delaying longer (p = 0.001). The first response of others was also an independent predictor of delay time (p = 0.003) with those who called the emergency services number or took the patient to hospital resulting in the shortest patient delays. Finally, if the patient appraised their symptoms as serious they had a shorter delay time (p = 0.02). CONCLUSIONS: The message about the emergent nature of stroke may be helping to improve delay times. However, there are still many people who delay greater than 3 h after symptom onset. It is important to direct education programs to those with known risk factors for stroke and their families, who often make the decision to call an ambulance.     

Factors associated with early hospital arrival in acute ischemic stroke patients

Early diagnosis and treatment in acute ischemic stroke are crucial in terms of survival and disability. Many stroke patients remain disabled because of the treatment delay. The purpose of this study was to investigate the factors associated with the early hospital arrival in acute ischemic stroke patients. 113 patients diagnosed with acute ischemic stroke were included in this prospective study performed at the Karadeniz Technical University Medical Faculty Hospital. Patients’ characteristics and patients’ and relatives’ emotional and behavioral reactions were compared between early (within 3 h) and late (after 3 h) arrival groups. 72.6 % of patients arrived at hospital within 3 h from symptoms onset. Univariate analysis revealed that history of atrial fibrillation (p = 0.04) and coronary heart disease (p = 0.02), sudden onset of symptoms (p = 0.001), loss of consciousness (p = 0.03), recognizing symptoms as stroke (p = 0.01), seeking immediate medical attention (p < 0.001), feelings of fear and panic (p = 0.001), arriving at hospital by ambulance having called the emergency medical services (p = 0.04) and National Institute of Health Stroke Scale (NIHSS) score (p = 0.001) were associated with hospital arrival within 3 h. A multivariate regression model demonstrated that recognizing symptoms as stroke (OR, 3.4; 95 % CI, 1.2–9.3) and atrial fibrillation (OR, 4.3; 95 % CI, 1.1–15.7) were independent factors associated with early arrival. The role in early arrival at hospital of recognizing symptoms as stroke and seeking immediate medical attention with transportation by ambulance emphasize the importance of public awareness concerning recognizing the symptoms of stroke and accessing emergency medical assistance.