基于昆山市医疗联盟城镇联动救治机制治疗急性脑梗死患者的策略研究

A strategic study on the treatment of patients with acute cerebral infarction based on the urban linkage treatment mechanism of Kunshan Medical Alliance

目的探讨基于昆山市医疗联盟城镇联动救治机制的急性脑梗死(AIS)患者的策略,为建立符合昆山地区脑梗死规范诊治管理模式,提升AIS救治率,降低致残率提供理论依据。方法采用回顾性方法收集2019-04—2022-06在以昆山市第一人民医院为中心就诊的186例AIS病例资料。统计AIS病例治疗有效率、认知功能[简易精神状态评价量表(MMSE)、蒙特利尔认知量表(MoCA)]、神经功能[美国国立卫生研究院卒中量表(NIHSS)]、预后[Rankin修订量表(mRS)]、复发率。结果186例患者救治总有效率为88.17%(164/186);患者血管血运开通后第1天、1周、3个月、6个月MMSE、MoCA评分均高于治疗前(P<0.05),NIHSS评分低于治疗前(P<0.05);患者脑血管血运开通后第3个月、6个月mRS评分均低于治疗前(P<0.05);患者出院后3个月、6个月总复发率分别为1.92%(3/156)、6.34%(9/142)。结论基于昆山市医疗联盟城镇联动救治机制的AIS患者早期个体化再灌注治疗策略可提升患者救治成功率,改善患者认知功能、神经功能,预防AIS复发,有效改善预后。

Objective To diseuss the strategy of acute cerebral infarction(AIS)patients based on the urban linkage treatment mechanism of Kunshan Medical Alliance,which provided a theoretical basis for establishing a standardized diagnosis and treatment management model for cerebral infarction in Kunshan City,improving the treatment rate of AIS,and reducing the disability rate.Methods A retrospective study was conducted to collect data of 186 cases of AIS in Kunshan First People’s Hospital from April 2019 to 2022.The therapeutic response rate,cognitive function[mini mental state assessment scale(MMSE),Montreal cognitive scale(MoCA)],neurological function[National Institutes of Health stroke scale(NIHSS)],prognosis[modified Rankin scale(mRS)]and recurrence rate of AIS cases were analyzed.Results The total effective rate of 186 patients was 88.17%(164/186).MMSE and MoCA scores were higher than before treatment(P<0.05),and NIHSS scores were lower than before treatment(P<0.05)at 1 d,1 week,3 months,and 6 months after vascular revascularization.mRS scores at 3 and 6 months after cerebrovascular transport were lower than before treatment(P<0.05).The total recurrence rates were 1.92%(3/156)and 6.34%(9/142)at 3 and 6 months after discharge,respectively.Conclusion The early individualized reperfusion therapy strategy for AIS patients based on the combined treatment mechanism of Kunshan Medical alliance town can improve the success rate of treatment,improve the cognitive function and neurological function of patients,prevent the recurrence of AIS,and effectively improve the prognosis.