急性缺血性脑卒中MSU与常规救治疗效的对比分析

Comparative analysis of MSU and routine treatment of acute ischemic stroke

目的对比分析应用移动卒中单元(MSU)与常规救治模式对急性缺血性脑卒中(AIS)的治疗效果。方法选取河南大学附属南石医院脑病重症科自2019年10月至2020年1月收治的AIS患者60例,采用随机数字表法将患者分为MSU组(30例)和常规组(30例)。MSU组采用装配了16排移动CT的MSU在卒中发生现场进行神经功能学评估、脑部移动CT扫描诊断及重组组织型纤溶酶原激活物阿替普酶(rt-PA)静脉溶栓治疗;常规组采用常规救治模式,由120现场急救并转运患者至医院,在急诊科进行神经功能学评估、CT脑扫描成像,专家会诊确诊,入住卒中专科进行rt-PA静脉溶栓治疗。对比分析2组患者首次医学接触时间、完成CT脑扫描时间、rt-PA静脉溶栓时间,以及溶栓治疗前后神经功能缺损程度变化和临床疗效。结果MSU组的治疗总有效率高于常规组,差异具有统计学意义(P<0.05)。MSU组首次医疗接触至完成头颅CT检查时间明显少于常规组(平均时间缩短28.72 min),首次医疗接触至静脉溶栓开始时间明显少于常规组(平均时间缩短34.81 min),2组比较差异均具有统计学意义(P<0.05)。MSU组治疗后的美国国立卫生研究院卒中量表评分优于常规组,差异有统计学意义(P<0.05)。结论AIS运用MSU模式进行rt-PA静脉溶栓治疗,可以显著缩短CT脑扫描时间和rt-PA静脉溶栓时间,对改善患者神经功能和提高临床疗效作用显著。

Objective To compare and analyze the effectiveness of mobile stroke unit(MSU)and conventional treatment mode of acute ischemic stroke(AIS).Methods Sixty patients with AIS were selected from Encephalopathy Department of Nanshi Hospital Affiliated to Henan University from October 2019 to January 2020.The patients were randomly divided into MSU group(30 cases)and routine group(30 cases).In the MSU group,MSU equipped with 16-slice mobile CT was used to evaluate the neurological function,brain mobile CT scanning diagnosis and recombinant tissue-type plasminogen activator alteplase(rt-PA)intravenous thrombolysis for AIS.The patients in the routine group under routine treatment mode were initially treatment by first aid on site and transported to the hospital by 120 ambulance.The neurological assessment,brain CT scanning were performed in the Emergency Department.The diagnosis was determined in stroke experts.Then the patients were admitted to the stroke center for rt-PA intravenous thrombolysis.The initial contact time,CT scan time,rt-PA thrombolytic time,and the degree of neurological deficit before and after thrombolytic therapy were compared and analyzed between the two groups.Results The total effective rate of MSU group was higher than that of routine group,the difference were statistically significant(P<0.05).The time from the first medical contact to the completion of head CT examination in MSU group was significantly less than that in routine group(the average time was shortened by 28.72 min),and the time from the first medical contact to the start of intravenous thrombolysis was significantly less than that in routine group(the average time was shortened by 34.81 min).The difference between the two groups was statistically significant(P<0.05).The change of NIHSS score in MSU group was better than that in routine group(P<0.05).Conclusion The use of MSU mode for AIS can significantly shorten the time of brain CT scanning and rt-PA intravenous thrombolysis for the treatment of rt-PA intravenous thrombolysis,which resulted in significant improvement of neurological function and clinical efficacy of AIS patients.