威海市急性脑梗死院前延迟的原因分析与对策

目的研究威海市区2家医院脑梗死患者到达医院前时间（院前延迟）的影响因素及对策。方法回顾性研究了进入医院急诊就诊的急性脑梗死病人的院前延迟影响因素，并制定相应对策。对所有资料分别采用KruskalWal—lis检验方法和logistic回归进行单变量和多变量分析。统计学软件采用SPSS12．0和SAS6．0。结果患者平均到达医院急诊时间为312min，27．27％于发病2h内到达医院急诊，42．08％于发病5h内到达医院急诊。单因素分析显示：女性、非独居、有医疗保险、首发症状为传统症状、病人能识别卒中症状、病人或救助者能认识脑梗死治疗紧迫性、由120救护车或110警车进行运送有利于及早到达医院急诊。多因素回归模型显示：影响及早到达医院急诊最重要因素是运送方式和首发症状，使用120救护车或110警车运送病人而非使用其他运送方式和卒中表现为传统症状能缩短入院时间。结论57．92％急性脑梗死患者不能在发病后5h内到达医院。为了缩短到达医院急诊时间，应加强对民众急性脑梗死知识的宣传教育；提高社区医生脑梗死诊治水平；进一步完善城镇基本医疗保险制度和新型农村合作医疗制度建设，扩大参保、参合率；重视敬老院、老年公寓建设，减少独居老年人比例。

Countermeasures and reasons for prehospital delays in the care of acute cerebral infarction in Weihai

Objective To study the prehospital time and influence factors of acute cerebral infarction（ACI） patients in 2 hospitals of Weihai and establish some countermeasures. Methods We prospectively studied the admission delay of acute cerebral infarction patients wbo presented to the emergency department （ED） of the study hospital within 48 hours of symptom onset. Results Median admission time is 312 minutes. The present study shows that 27.27% ≤2 hours and 42.08% ≤5 hours of the patients arriving in the ED after the onset. Univariate analysis showed that early the ED arrival was significantly associated with the following factors： female, hospitalization insurance, traditional symptoms of stroke, not living alone, recognition of symptoms by patients or helpers, awareness of the pressure to be treated and transport by 120 ambulances or 110 police wagons. A multivariate regression model demonstrated that the most significant factors associated with early ED arrival were transported by 120 ambulances or 110 police wagons and traditional symptoms of stroke. Female and not living alone were also significantly associated with early admission in the multivariate model. Conclusion 57.92% stroke patients arrived at the ED over 5 hours. For shorting the patients＇ arriving at the ED＇s time, further health education is necessary to increase the public awareness about ACI. We should improve community doctors＇ level of diagnosis about ACI through further education. It is necessary to perfect and extend the Urban Medical Insurance System and new rural cooperative medical care system. In the same way, we should build out sufficient geracomiums and boarding houses for all elderly people.