依托急诊建立卒中中心对急性缺血性脑卒中预后的影响

Influence of establishing stroke center based on emergency department on prognosis of acute ischemic stroke

目的 探讨依托急诊建立卒中中心对急性缺血性脑卒中(acute ischemic stroke, AIS)预后的影响。方法 随机调取2019年在郑州市紧急医疗救援中心主导下,依托急诊科,联合院内多学科建立卒中中心4家综合性医院632例AIS中病例,拨打“120”经院前急救按照卒中地图转送医院314例AIS患者为观察组,自行到院的318例AIS患者为对照组。比较两组患者临床疗效、救治时间,治疗前后神经功能缺损情况、并发症及预后情况。结果 观察组总有效率为98.41%,高于对照组的91.82%(P<0.05)。观察组发病到入院用时、开通静脉用时、CT检查完成用时、入院到开始静脉溶栓用时、开通血管用时均短于对照组(P<0.05)。治疗后,两组NIHSS评分均较治疗前下降(P<0.05);治疗后,观察组NIHSS评分低于对照组(P<0.05)。两组死亡率差异无统计学意义(P>0.05),观察组并发症发生率(5.73%)低于对照组(15.09%)(P<0.05)。结论 依托急诊科建立卒中中心,联合多学科实施救治缩短了AIS患者开通血管用时,为溶栓治疗和和介入治疗争取了时机,进而提高疗效和生存率,减少致残和死亡发生率。

Objective To investigate the effect of establishing a stroke center based on emergency department on the prognosis of acute ischemic stroke(AIS). Methods Under the leadership of Zhengzhou Emergency Medical Rescue Center in 2019, 632 cases of AIS were randomly selected from 4 general hospitals, which were established in 2019 by the emergency department and the multi-disciplinary establishment of the stroke center in the hospital. 314 patients with AIS who were transferred to the hospital by troke ap were selected as the observation group, and 318 patients with AIS who were admitted to the hospital by themselves were selected as the control group. The clinical efficacy, treatment time, neurological deficit, complications and prognosiswere were compared between the two groups. Results The total effective rate of the observation group was 98.41%, which was higher than that of the control group(91.82%)(P<0.05). Compared with control group, the time from onset to hospital arrival, stroke identification, blood drawing, completion of CT examination and blood vessel opening were significantly shortened in the observation group(P<0.05). After treatment, the NIHSS scores of the two groups were lower than before treatment, and the NIHSS score of the observation group was lower compared with control group(P<0.05). The mortality had no significant difference between the two groups(P>0.05), and the incidence of complications in the observation group(5.73%) was lower compared with control group(15.09%)(P<0.05). Conclusion Relying on the emergency department to establish a stroke center, combined with multidisciplinary treatment, greatly shortened the vascular patency time of patients with AIS, improved the patient’s treatment effect, won more opportunities for thrombolysis and intervention for the patient, and improved the efficacy survival rate, reduced morbidity and mortality.