“三位一体”急救模式对急性脑卒中救治和预后的影响

目的探讨"120"院前急救—急诊室救治—ICU及专科病房救治"三位一体"的急救模式对急性脑卒中患者诊治的临床价值。方法选择脑卒中患者196例,根据来院方式不同分为两组:经"120"现场救护并送来本院就诊的100例作为研究组,自行就诊的患者96例作为对照组。患者院前急救、院内急诊救治效果、住院前和住院第7天时神经功能缺损程度、两组患者住院期间和治疗3个月时病死率和并发症作为判断疗效的指标,比较两组的疗效。结果发病到入院时间、窒息、抽搐和病死率对照组较研究组明显升高,差异具有统计学意义(P<0.05),两组院前脑疝的发生率和神经功能缺损程度评分比较,差异无统计学意义;对照组影像学诊断时间、入住专科时间、延续病死率和住院第7天时神经功能缺损程度评分都高于研究组,差异具有统计学意义(P<0.05);在治疗3个月内,两组比较病死率差异有统计学意义(P<0.05),但住院期间两组病死率差异无统计学意义,出院后病死率和再卒中者,两组间差异有统计学意义(P<0.05)。结论推广三位一体的急救模式是目前降低急性脑卒中患者病死率和致残率的重要手段。

A new type of first aid mode called trinity in treatment and prognosis of acute stroke patients

Objective To study the effect of a new type of first aid mode called trinity,including pre - hospital care, emergen- cy management, special wards management, on diagnosis and treatment of acute stroke （AS） patients. Methods 196 new stoke pa- tients admitted to our emergency department from January 2008 to May 2011 were divided into groups of test （n = 100） and control （ n = 96 ）. Pre - hospital emergency, in - hospital rescue, case fatality, neurologic impairment levels in the hospital and complications over three months were calculated. Results Time of admission to the emergency department and the rate of asphyxiation, convulsion and fatality in control group were well above those in test group （ P 〈 0.05 ）. No significant difference was noted in the incidence of cer- ebral hernia and score of neurologie impairment levels between the two groups. The time taken by medical imaging diagnosis, time of ad- mission to special wards, the continued fatality rate and the score of neurologic impairment levels in control group after seven days of hospital stay compared favorably with the test group （ P 〈 0.05 ）. There was no significant difference between the two groups in mortali- ty （ P 〉 0.05 ）. By the end of the third month, there was significant difference between the two groups in mortality （ P 〈 0.05 ）, post - discharge mortality and relapse of stroke （ P 〈 0.05 ）. Conclusion A This new type of first aid mode is an important means of reducing stroke disablement and elevating the life quality of stroke victims.