脑卒中患者急救医疗服务流程现状及临床研究

Current situation and clinical research of emergency medical service flow in stroke patients

目的对医院脑卒中的急救医疗服务（emergency medical service，EMS）流程进行调查，以提高脑卒中EMS的质量，为完善脑卒中EMS提供依据。方法2013年6月一2015年7月由石河子大学医学院第一附属医院急救中心调查研究人员亲自参与EMS，并且将医院的EMS细分成4个阶段：EMS启动、反应、现场救治、转运。使用脑血管病防治指南和美国缺血性脑卒中自制调查表和早期处理指南进行调查，研究对象包括脑卒中患者和家属，对EMS救治人员的反应能力、反应速度和现场处理措施进行评价。结果脑卒中EMS中120急救电话分别是由患者、旁观者和家属拨打。从患者开始发病到拨打电话的过程，时间在3min以内的占7．33％，在30min以内的占34．67％，超30min的占58％。在拨打急救电话后，有84％的急救车能够及时出发并到达。EMS人员未使用院外卒中工具进行筛选，对60．12％的患者未进行相关的处理和鉴别。结论在一般情况下，同相关的指南作比较，EMS人员询问大多数患者的既往史，为患者通知相关医院，并且进行相关治疗，体现了急救医疗的重要性。

Objective To investigate the emergency medical service （emergency, medical, service, EMS） of stroke patients in order to improve the quality of EMS in stroke, and to provide evidence for the improvement of EMS in stroke. Methods investigators were personally involved in the EMS of the hospital emergency station and subdivided the hospital＇s EMS into 4 phases： EMS initiation, response, field treatment, and transportation. The use of cerebrovascular disease prevention and treatment guidelines and the ischemic stroke questionnaire and early treatment guidelines were investigated, including the research object of stroke patients and their families, to evaluate the treatment of EMS personnel reaction ability, reaction speed and on-site treatment measures. Results in the stroke EMS, 120 emergency calls were made by patients, bystanders and relatives by dialing 2.13%, 20.73% and 77.14% respectively. From the onset of patients to call the process, the time within 7.33% of 3min, accounting for 34.67% in 30min, accounting for 58%more than 30min. After dialing emergency calls, however, 85% of ambulances were able to leave and arrive in due course. EMS staff were not screened using prehospital stroke instruments, and 60.12% of the patients were not treated and identified. Conclusions in general, compared with the relevant guidelines, EMS staff ask for the past history of most patients, inform patients of related hospitals, and conduct related treatment, which reflects the importance of emergency medical treatment.