北京地区急性缺血性脑卒中患者延迟入院原因调查分析

Analysis of the Reasons for Delayed Admission of Patients with Acute Ischemic Stroke in Beijing Area

背景急性缺血性脑卒中是威胁人类健康的主要疾病,静脉溶栓是当前比较有效的治疗方法之一,但该治疗在3.0-6.0 h内有效。目的了解北京地区急性缺血性脑卒中患者延迟入院的原因。方法采用横断面调查,选取2013年12月—2014年3月首都医科大学宣武医院、北京大学第三医院、首都医科大学附属北京朝阳医院及首都医科大学潞河教学医院4家三级医院的472例急性缺血性脑卒中患者,采用自行设计的调查问卷,内容包括患者基本信息、就诊情况、院前延迟情况及延迟入院的原因。结果首诊医院级别：三级医院380例（80.51%）、二级医院62例（13.14%）、一级医院及以下30例（6.35%）;首诊科室：急诊375例（79.45%）、门诊97例（20.55%）;首诊转运途径中使用急救车（120或999）94例（19.92%）、私家车232例（49.15%）、公共交通工具97例（20.55%）、其他49例（10.38%）。院前时间0.3-138.2 h,中位数为4.4（四分位数间距为14.7）h;正常入院患者214例（45.34%）,延迟入院患者258例（54.66%）。正常入院与延迟入院患者首诊医院级别比较,差异无统计学意义（P〉0.05）;正常入院与延迟入院患者首诊科室、首诊转运途径比较,差异均有统计学意义（P〈0.05）。患者延迟入院的常见原因依次为症状归因于其他疾病（22.09%,57/258）、症状不明显未识别（17.83%,46/258）、没人帮助或受他人影响（11.63%,30/258）。结论患者及家属对急性缺血性脑卒中的认知因素与发病环境因素是患者延迟入院的主要原因。今后要加强急性缺血性脑卒中知识的健康教育,发挥基层医院在防治工作中的作用。

Background Acute ischemic stroke is one of the main diseases menacing human＇s health. At present,intravenous thrombolysis is an effective treatment method, treatment in the first 3. 0- 6. 0 hours of illness is effective.Objective To investigate the reasons for delayed admission of patients with acute ischemic stroke in Beijing area. Methods A cross- sectional survey was undertaken from December 2013 to March 2014,472 patients with acute ischemic stroke in Xuanwu Hospital Capital Medical University,the Third Hospital of Peking University, Beijing Chaoyang Hospital Affiliated to Capital Medical University, and the Luhe Teaching Hospital of Capital Medical University, were investigated by a self- designed questionaire,the content of questionaire included general information of patients, the information of seeking treatment, the information and reasons for delayed admission. Results The first hospital： 380 cases（ 80. 51%） in tertiary hospital,62（ 13. 14%） in secondary hospital,30（ 6. 35%） in first- level hospital; the first department： 375 cases（ 79. 45%） in department,97 cases（ 20. 55%） in outpatient department; the first transport method： 94 cases（ 19. 92%） by ambulance（ 120 or 999）,232（ 49. 15%） by private car,97（ 20. 55%） by public transport,49（ 10. 38%） by other means. Time from symptom onset to hospital admission（ onset- to- door time） ranged from 0. 3 h to 138. 2 h,and the median was 4. 4 h（ the interquartile range was 14. 7 h）. 45. 34%（ 214 cases） of patients were transported to hospital on time,and the admission for 54. 66%（ 258 cases） of patients was delayed. There was no significant difference in the first hospital between no- delay group and delay group（ P〉 0. 05）. There were significant differences in the first department and transport method between two groups（ P〈 0. 05）. The reasons for delayed hospital admission were： symptoms were attributed to other diseases（ 22. 09%,57 /258）,symptoms were too mild to identify（ 17. 83%,46 /258）,could not get help or influenced by others（11. 63%,30 /258）,in that order. Conclusion The cognitive factors of patients and their family members,and environmental factors of stroke onset were main reasons for delayed admission. More efforts are needed to improve health education on the knowledge of acute ischemic stroke. The primary hospital should play a greater role in stroke prevention and treatment.