某医院急性缺血性卒中患者诊治延迟因素调查及干预措施

Investigation and intervention of delayed factors in diagnosis and treatment of acute ischemic stroke patients in a hospital

目的:探讨急性缺血性卒中患者诊治延迟因素。方法:选取2015年10月至2018年10月间,我院157例急性缺血性卒中患者,结合溶栓时间窗,将86例发病至诊治时间≥4.5 h者分为延迟诊治组,其余71例发病至诊治时间<4.5 h者分为正常诊治组。分析所有患者基本状况、就诊情况,并统计分析延迟诊治组患者延迟诊治原因。结果:两组患者性别、年龄、受教育程度、医保类型比较,差异无统计学意义(P>0.05);两组首诊医院级别间,差异无统计学意义(P>0.05),但延迟诊治组首诊科室急诊率(73.3%)低于正常诊治组(87.3%,P<0.05);延迟诊治组首诊转运途径中应用公共交通工具率(27.9%)高于正常诊治组(11.3%),应用急救车率(14.0%)低于正常诊治组(28.2%,P<0.05);导致延迟诊治的原因中症状归类于其他疾病(22.1%)、症状不突出未识别(17.4%)、患者或者家人或第一发现者未能正确认知脑卒中(11.6%)、发病地点至医院距离(10.5%)所占比相对较高。结论:导致急性缺血性卒中患者诊治延迟的原因较多,可对疾病疗效与预后产生不利影响,临床可结合相关因素通过加强健康宣教等避免诊治延迟发生。

Objective:To investigate the delayed factors in the diagnosis and treatment of patients with acute ischemic stroke.Methods:A total of 157 patients with acute ischemic stroke(October 2015-October 2018)were enrolled in our hospital.Combined with the time window of thrombolysis,86 patients with onset to diagnosis and treatment time≥4.5 h were divided into delayed diagnosis and treatment group,the remaining 71 cases were divided into the normal diagnosis and treatment group when the time from onset to diagnosis and treatment was<4.5 h.A self-designed questionnaire was used,statistics on the basic conditions of all patients(gender,age,education level,type of medical insurance),medical treatment[including the first hospital level(level 3,level 2,level 1 and below),the first department(outpatient,emergency department)],the first diagnosis of transit routes(public transport,private cars,ambulances)],and the causes of delayed diagnosis and treatment of patients(history of stroke,first-level primary medical institutions,luck and resistance to disease,night or holiday onset,waiting and observation,long treatment time,distance from the onset location to the hospital,patients or family or the first finder did not correctly recognize the stroke,the symptoms were not prominent and unrecognized,and the symptoms were classified as other diseases)in the delayed diagnosis and treatment group were statistically analyzed.Results:Basic status:There was no significant difference in gender,age,education level and medical insurance type between the two groups(P>0.05);②First hospital level and first department:There was no significant difference between the two first hospital levels(P>0.05),but the rate of emergency department(73.3%)in the first consultation department of the delayed diagnosis and treatment group was lower than that of the normal diagnosis and treatment group(87.3%,P<0.05).③The first diagnosis and delivery route:the first them,symptoms were classified into other diseases(22.1%),symptoms were not prominent and unrecognized(17.4%),patients or family members or the first discoverer failed to correctly recognize stroke(11.6%),and the distance from the place of onset to the hospital(10.5%)was relatively high.Conclusions:There are many reasons diagnosis and treatment group The rate of application of public transport(27.9%)was higher than that of the normal diagnosis and treatment group(11.4%),and the rate of application of emergency vehicles(14.0%)was lower than that of the normal diagnosis and treatment group(28.2%,P<0.05);Reasons for delayed diagnosis and treatment:Statistical analysis showed that there are many reasons for delayed diagnosis and treatment,amongfor delay in the diagnosis and treatment of patients with acute ischemic stroke.Such factors may adversely affect the overall efficacy and prognosis of the disease.Clinical practice can be combined with its related factors to avoid delays in diagnosis and treatment by strengthening health education and improving diagnosis and treatment measures.occur.