急性缺血性脑卒中患者院前及院内延迟因素调查研究

目的探讨急性缺血性脑卒中患者发病后就诊及接受治疗情况,就其就诊及治疗延迟因素进行分析,从而寻求可能的解决方法。方法连续收集我院2011年7月—2011年11月急性缺血性脑卒中患者231例,对其院前及院内延迟因素进行比较分析。结果发病后3 h内于我院就诊患者为36例(15.6%);延迟就诊组与及时就诊组患者的职业状态、脑卒中史、医疗保险、发病模式、发病地与我院的距离、首诊医院、到达首诊医院采用的交通工具、是否呼叫急救车、入院时美国国立卫生院神经功能缺损评分(NIHSS)各项因素比较,差异均有统计学意义(P<0.05)。首诊医院非我院、未呼叫急救车、居住地与我院的距离及在职人员,其就诊延迟危险因素均增加,差异有统计学意义(P<0.05);有脑卒中史及NIHSS较高的患者,其就诊延迟的危险性均降低,差异有统计学意义(P<0.05);退休患者就诊危险性降低,差异无统计学意义(P>0.05)。院内延迟各个时间段均与美国国立神经病与卒中研究所(NINDS)的要求比较,差异有统计学意义(P<0.05);院内延迟情况门诊就诊组与急诊科就诊组比较,差异有统计学意义(P<0.05)。结论加强公众对卒中知识及早期就诊的重要性认识、提高急诊急救系统的宣传使用,加强卒中单元规范化建设对急缺血性脑卒中的早期诊治具有重要意义。

Pre-hospital and In-hospital Delay after Acute Ischemic Stroke among 231 Patients

Objective To explore pre-hospital and in-hospital delays after acute ischemic stroke and their influencing factors.Methods A total of 231 patients with acute ischemic stroke were consecutively enrolled in our hospital from July 2011 to November 2011.Factors that might influence the pre-hospital and in-hospital delay were surveyed.Results Of 231 patients,36(15.6%) were presented at our hospital within 3 hours after disease onset.Career,previous history of stroke,medical insurance,onset mode,distance between stroke onset site to hospital,first hospital arrived,transportation mode,use of ambulance,NIHSS at admission were significantly different between the timely group and the delayed group(P<0.05).The temporal distribution of in-hospital delay showed significant difference with the NNIDS reference time(P<0.05).In addition,in-hospital delay significantly differed between patients who were presented at the outpatient departments or emergency services.Conclusion Many factors may affect the timely admission of ischemic stroke patients.Efforts should be made for patient education and hospital management.