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1.
目的 调查中国卒中单元对缺血性卒中患者收治的现况,并探索卒中单元对改善卒中医疗质量绩效
指标及患者在院预后的影响。
方法 本研究数据来自中国多中心缺血性卒中住院患者登记研究。按照是否进入卒中单元,将
研究对象分为卒中单元组与非卒中单元组。比较两组间患者的卒中医疗质量关键绩效指标(key
performance index,KPI)和在院预后(卒中复发、联合血管事件、全因死亡)的差异,并采用多因素回归,
分析与卒中单元相关的KPI及卒中单元与缺血性卒中患者在院预后的相关性。
结果 本研究共纳入了全国1374家医院的269 428例急性缺血性卒中住院患者。其中,63 548例
(23.6%)患者纳入卒中单元组。卒中单元与较高比例的rt-PA静脉溶栓(OR 1.48,95%CI 1.43~1.53)、
早期抗栓治疗(OR 1.13,95%CI 1.10~1.17)、深静脉血栓预防(OR 1.19,95%CI 1.16~1.22)、吞
咽功能筛查(OR 1.36,95%CI 1.32~1.39)、康复评估(OR 1.31,95%CI 1.28~1.34)、出院抗栓治疗
(OR 1.12,95%CI 1.08~1.15)、合并心房颤动患者抗凝治疗(OR 1.13,95%CI 1.08~1.19)、戒烟宣教
(OR 1.22,95%CI 1.20~1.25)独立相关,与较低的在院卒中复发率(HR 0.79,95%CI 0.75~0.82)和
联合血管事件发生率(HR 0.80,95%CI 0.77~0.84)独立相关(均P <0.001)。
结论 进入卒中单元的缺血性卒中患者,卒中医疗质量KPI完成较好,在院卒中复发率及联合血管事
件率较低。 相似文献
2.
目的 调查中国卒中单元对缺血性卒中患者收治的现况,并探索卒中单元对改善卒中医疗质量绩效
指标及患者在院预后的影响。
方法 本研究数据来自中国多中心缺血性卒中住院患者登记研究。按照是否进入卒中单元,将
研究对象分为卒中单元组与非卒中单元组。比较两组间患者的卒中医疗质量关键绩效指标(key
performance index,KPI)和在院预后(卒中复发、联合血管事件、全因死亡)的差异,并采用多因素回归,
分析与卒中单元相关的KPI及卒中单元与缺血性卒中患者在院预后的相关性。
结果 本研究共纳入了全国1374家医院的269 428例急性缺血性卒中住院患者。其中,63 548例
(23.6%)患者纳入卒中单元组。卒中单元与较高比例的rt-PA静脉溶栓(OR 1.48,95%CI 1.43~1.53)、
早期抗栓治疗(OR 1.13,95%CI 1.10~1.17)、深静脉血栓预防(OR 1.19,95%CI 1.16~1.22)、吞
咽功能筛查(OR 1.36,95%CI 1.32~1.39)、康复评估(OR 1.31,95%CI 1.28~1.34)、出院抗栓治疗
(OR 1.12,95%CI 1.08~1.15)、合并心房颤动患者抗凝治疗(OR 1.13,95%CI 1.08~1.19)、戒烟宣教
(OR 1.22,95%CI 1.20~1.25)独立相关,与较低的在院卒中复发率(HR 0.79,95%CI 0.75~0.82)和
联合血管事件发生率(HR 0.80,95%CI 0.77~0.84)独立相关(均P <0.001)。
结论 进入卒中单元的缺血性卒中患者,卒中医疗质量KPI完成较好,在院卒中复发率及联合血管事
件率较低。 相似文献
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移动卒中单元(mobile stroke unit,MSU)和第五代移动通信技术(5th generation mobile
communication technology,5G)相结合构成了5G移动卒中单元(5G MSU),其在卒中急救方面表现出强
大的应用潜力。5G MSU利用物联网、移动互联网、云计算、5G等新一代信息通信技术,将MSU、急救中
心、卒中中心和医疗机构等各模块有效地连接起来,改变了传统的卒中院前救治模式,将急救工作
前移,实现“上车即入院”的目标,显著缩短了患者发病到静脉溶栓时间。在早期研究中,多项临床研
究证实了MSU在急性卒中救治中的可行性和安全性,但其能否改善患者的预后及降低死亡率尚未明
确。本文就5G MSU的概念、发展、国内外研究进展等内容进行综述。 相似文献
6.
组织化卒中医疗模式对急性脑卒中的效果研究 总被引:2,自引:0,他引:2
目的:探讨组织化卒中医疗模式治疗急性脑卒中的效果。方法:将符合标准的175例急性脑卒中患者随机分为组织化卒中治疗组(A组)及常规治疗组(B组)进行治疗,比较分析两组临床神经功能缺损程度、日常生活活动能力、意识障碍程度、并发症及近期临床疗效的差异。结果:A组在神经功能缺损程度评分、日常生活活动能力评分、意识障碍程度评分及近期临床疗效方面,均明显优于B组(均P<0.01),并发症的发生率亦显著低于B组(P<0.01)。结论:组织化卒中医疗模式治疗急性脑卒中有确切疗效。 相似文献
7.
目的 大多数急性缺血性卒中患者难以在发病早期接受静脉溶栓治疗,而移动卒中单元(mobile
stroke unit,MSU)的应用将静脉溶栓治疗从院内提到院前。本研究初步探讨中国首台MSU在急性卒中
患者院前静脉溶栓中的作用。
方法 回顾性分析荥阳市人民医院卒中中心2018年11月-2019年4月期间应用MSU进行院前静脉溶
栓的患者(MSU溶栓组)和使用传统救护车转运至院内静脉溶栓的患者(常规溶栓组)的临床资料。
观察终点包括主要时间指标从呼叫至溶栓时间、从发病至溶栓时间;疗效指标为90 d良好预后(mRS
评分≤2分)率;安全性指标包括溶栓后48 h内症状性颅内出血及随访90 d内的全因死亡。比较静脉
溶栓患者应用两种治疗模式的终点差异。
结果 MSU溶栓组共计14例患者接受了院外静脉溶栓,同时期常规溶栓组有24例患者在院内进行了
静脉溶栓治疗。与常规溶栓组相比,MSU溶栓组呼叫至溶栓时间(59 min vs 92 mi n,P =0.001)、发病
至溶栓时间(73 min vs 114 mi n,P =0.002)均较短。两组的90 d良好预后率(79% vs 67%,P =0.488)
和安全性指标均未见统计学差异。
结论 基于MSU的急性缺血性卒中院前溶栓可以显著缩短患者从发病至溶栓时间及呼叫至溶栓时
间,但对于急性卒中的救治疗效仍需要多中心前瞻性研究进一步验证。 相似文献
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Joe E. Acker Ⅲ Todd J. Crocco Edward C. Jauch Neil M. Meltzer John W. Munn Charles Sand Brian Eigel Brian R. Gilpin Mark Schoeberl Penelope Solis Katie B. Horton 曹勇军 李瑞霞 刘建芳 刘春风 《中华脑血管病杂志(电子版)》2008,2(6):354-370
尽管卒中的预防、诊断、治疗和康复已取得一些进展,但卒中在美国仍然是第三大死亡原因和长期残疾的主要原因。每年约有70万人新发或复发卒中。在过去10年里,急性卒中诊治的一些进展,包括纤溶和其他短期疗法的引入, 相似文献
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目的探讨中西医结合卒中单元治疗急性缺血性脑卒中的临床疗效和卫生经济学价值。方法随机选取符合入选标准的260例急性缺血性脑卒中(风痰瘀阻症)患者,分为实验组(中西医结合卒中单元组)和对照组(常规治疗组),两组均为130例。采用美国国立卫生院卒中量表(NIHSS)评分、Barthe1指数(BI)、改良的Rankin量表(mRS)为疗效观察指标;住院时间、住院费用、药品费用、检查和治疗费用为卫生经济学指标。比较NIHSS评分每减少1分、BI评分每增加5分、mRS评分每减少1分,患者每人每天所花费的住院费用。结果①与对照组比较,实验组治疗后14 d时NIHSS、BI、mRS改善程度明显优于对照组(P0.05)。实验组14 d后NIHSS评分下降主要在构音和运动功能方面优于对照组(P0.001);实验组BI评分提高主要在用厕、吃饭、移动、行走、穿衣、上楼、洗浴方面优于对照组(P0.01),实验组mRS(0~2)分的患者近期残障功能的改善优于对照组(P0.01)。②住院期间,两组患者的住院费用和检查费用差异无统计学意义(P0.05);实验组的平均住院时间和药品费用明显低于对照组(P0.01),治疗费用高于对照组(P0.001)。③NIHSS评分每减少1分,BI评分每增加5分,MRS评分每减少1分,实验组所需费用均较对照组少。结论中西医结合卒中单元治疗急性缺血性脑卒中更具有社会效益和经济效益。 相似文献
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Tsantes AE Nikolopoulos GK Bagos PG Bonovas S Kopterides P Vaiopoulos G 《Thrombosis research》2008,122(6):736-742
Plasminogen activator inhibitor (PAI-1), is the central component of the fibrinolytic system. A deletion/insertion (4G/5G) polymorphism in the promoter region of the PAI-1 gene has been correlated with levels of plasma PAI-1. The 4G allele is associated with higher levels of PAI-1, and might increase the risk for intravascular thrombosis. However, the contribution of this genetic variant to the risk for thrombosis, both arterial and venous, has not been clearly established. A broad spectrum of findings regarding the effect of the 4G allele on thrombotic risk in different target organs has been reported. Our aim is to summarize the variable influence of this polymorphism on thrombotic events in different tissues or organs and explain the underlying mechanisms accounting for these differences. 相似文献
14.
目的 探讨卒中单元病房通过品管圈工具的应用,制订出提高卒中单元患者满意度的改进措施和标
准化流程,并组织实施,最终改善患者满意度。
方法 2014年4月采取自愿报名的方法成立品管圈活动小组,学习品管圈相关知识,同时对患者进行
相关满意度调查,设为品管圈改善的基线指标。运用PDCA(Plan-Do-Check-Action)循环方法,设定品管
圈活动主题、把握现状、分析原因并制订对应策略。4个月后再次进行患者满意度调查,将本次结果
与基线指标进行比较,观察品管圈活动对患者满意度的改善情况。
结果 收集有效的基线调查问卷78份;品管圈活动后调查问卷80份。发现实施品管圈活动后,患者
对病房的满意度明显提高,由实施前的72%上升为实施后的93%,其中对于病房清洁满意度、病房安
静满意度提高显著(P =0.002,0.006)。此次品管圈活动目标达成率为116.6%,进步率为29.1%,说明
活动采取措施有效,通过品管圈活动,使卒中病房的患者满意度有了显著提高。
结论 品管圈活动对卒中病房管理效果显著。 相似文献
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目的观察卒中单元中中医熄风化痰活血法对急性脑梗死患者的神经保护作用。方法将符合诊断标准的病例随机分为对照组(36例)和治疗组(32例)。对照组给予西医常规治疗,治疗组在此基础上给予熄风化痰活血中医小复方辨证治疗,连续观察14d。两组在治疗前、治疗14d取静脉血行血清一氧化氮(NO)、内皮素-1(ET-1)、超氧化物歧化酶(SOD)、丙二醛(MDA)、可溶性细胞间黏附分子-1(sICAM-1)水平检测。结果两组治疗后NO均升高,并且治疗组与对照组间差异有统计学意义。治疗后血清SOD均升高、MDA和ET-1均下降,但两组间差异无统计学意义;血清sICAM-1治疗前后变化差异均无统计学意义。结论氧自由基损伤参与急性脑梗死病理过程,中西医治疗通过抗氧自由基减轻病理损伤;熄风化痰活血小复方治疗作用突出表现为促进扩血管物质NO的释放。 相似文献
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Ramón LA Gilabert-Estellés J Cosín R Gilabert J España F Castelló R Chirivella M Romeu A Estellés A 《Thrombosis research》2008,122(6):854-860
Introduction
Endometriosis is a benign gynecologic disease with a high prevalence. It is a multifactorial and polygenic entity in which the fibrinolytic system may be implicated. The objective of this study was to evaluate the plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism in a group of women with and without endometriosis and to analyze the influence of this polymorphism in PAI-1 expression in endometrial tissue and peritoneal fluid.Material and methods
In 389 women (170 patients with endometriosis and 219 controls) PAI-1 4G/5G polymorphism was determined by PCR amplification using allele-specific primers. Quantitative real-time RT-PCR assay was used to quantify PAI-1 mRNA and PAI-1 antigen (ag) levels were quantified by ELISA.Results
The genotype and allele frequencies of PAI-1 4G/5G polymorphism did not differ significantly between patients and controls. Control women with the 4G/4G genotype had higher endometrial PAI-1ag (P = 0.026) and mRNA (P = 0.014) levels than those with the 5G/5G genotype. Control carrying the 4G/4G genotype tended to have higher peritoneal fluid PAI-1ag levels than those carrying the 5G/5G genotype. Moreover, PAI-1ag levels in peritoneal fluid were higher in patients than in controls (P = 0.003).Conclusions
The PAI-1 genotype distribution was similar in patients and controls. PAI-1 levels in endometrial tissue and peritoneal fluid seem to be associated with PAI-1 4G/5G polymorphism in controls. The increased PAI-1ag levels observed in peritoneal fluid from patients could contribute to increase the peritoneal adhesions observed in endometriosis. 相似文献17.
Marie-christine Birling Monique Miehe Jean-louis Nussbaum 《Journal of neuroimmunology》1995,58(2):201-210
The C1G5F2 antigen is a newly described minor myelin antigen of the central nervous system. Its expression compared with that of some other main myelin protein components (Wolfgram W1 protein, myelin basic proteins (MBP) and proteolipids) was investigated in rat oligodendrocytes derived from 10-day-old primary glial cell cultures and subcultured for several days in a chemically defined medium. It was demonstrated immunocytochemically that this antigen is detected later than the major myelin markers. All cells immunoreactive with the monoclonal antibody C1G5F2 were always labeled either by W1-, MBP- or proteolipid-specific antisera. It was also shown at the electron microscopic level that this antigen is mainly expressed on the surface of the extremities of the fine oligodendroglial processes. All these observations suggest that the C1G5F2 antigen may be a useful marker for a specific step in the oligodendrocyte maturation stage. 相似文献
18.
Gilabert-Estellés J Ramón LA Braza-Boïls A Gilabert J Chirivella M España F Estellés A 《Thrombosis research》2012,130(2):242-247
Plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism may have significance for PAI-1 expression. High levels of PAI-1 in endometrial cancer patients are associated with a poor prognosis. The objective of this study was to evaluate the PAI-1 4G/5G polymorphism in women with and without endometrial cancer and to analyze the influence of this polymorphism on PAI-1 expression in endometrial tissue.In 423 women (212 patients with endometrial cancer and 211 controls) PAI-1 4G/5G polymorphism was determined by PCR amplification using allele-specific primers. Quantitative real-time RT-PCR assay was used to quantify PAI-1 mRNA and PAI-1 protein levels were quantified by ELISA in tissue extracts from 33 patients with endometrial cancer and from 70 endometrial tissues from control women. The frequency of PAI-1 4G/4G genotype (P = 0.010) and the PAI-1 4G allele (P = 0.009) was significantly higher in patients than in controls. The frequency of PAI-1 4G allele was significantly higher in patients with stage IB than in those with stage IA (P = 0.03). Control women with the 4G/4G genotype had higher endometrial PAI-1 protein (P = 0.018) and mRNA (P = 0.004) levels than those with the 5G/5G genotype. A significant increase in PAI-1 protein and mRNA was observed in endometrial cancer tissue in comparison with the endometrial tissue from control women (P < 0.01). In conclusion, frequencies of the PAI-1 4G allele and 4G/4G genotype were found significantly more often in women with endometrial cancer than in controls. PAI-1 levels in endometrial tissue seem to be associated with PAI-1 4G/5G polymorphism. These findings suggest that the PAI-1 4G/4G genotype may be associated with the risk of endometrial cancer in a Caucasian population. Further studies with a larger number of patients are needed to clarify the influence of this PAI-1 polymorphism in endometrial cancer. 相似文献
19.
《Journal of clinical neuroscience》2014,21(6):975-979
The effect of activating 5-lipoxygenase (ALOX5AP) gene polymorphisms on stroke risk may be influenced by the coexistence of modifiable predisposing conditions. We explored the interactions of ALOX5AP polymorphisms and cigarette smoking in a case-control study of patients with atherosclerotic cerebral infarction (ACI). Three polymorphisms of the ALOX5AP gene (rs10507391, rs4769874, and rs9551963) were analyzed in 420 ACI patients and 488 unrelated healthy controls matched for age and sex from a Northern Han Chinese population. Among the three single nucleotide polymorphisms, only rs10507391 genotype TT/TA was observed to be associated with an increased risk of ACI on multivariate analysis (odds ratio [OR] = 1.82, 95% confidence interval [CI] = 1.14–2.92, p = 0.012) compared with the AA genotype. However, after stratifying by smoking status, multivariate logistic regression analysis revealed that rs10507391 genotype TT/TA and rs9551963 genotype CC/CA had a 5.63-fold (OR = 5.63, 95%CI = 2.00–15.84, p = 0.001) and a 2.71-fold (OR = 2.71, 95%CI = 1.28–5.73, p = 0.009) increased risk for ACI patients who smoked compared with the AA genotype, respectively. Additionally, according to the haplotype analysis, the risk of haplotype TGC (OR = 3.12, 95%CI = 2.00–4.88, p < 0.001, corrected p [pc] < 0.001) increased for ACI patients who smoked compared to the data (OR = 1.60, 95%CI = 1.28–1.98, p < 0.001, pc < 0.001) in total samples. These results suggest that ALOX5AP polymorphisms are associated with ACI, and cigarette smoking along with ALOX5AP could increase the risk of ACI. 相似文献