急性缺血性脑血管病患者就医延迟院外原因分析  

Factors associated with pre-hospital delays in acute ischemic stroke patients

作　　者：王彤歌[1] 马琦[2] 王浩[1] 

机构地区：[1]暨南大学附属第一医院神经内科,广州510630 [2]广东省人民医院惠福院区神经内科,广州510120

出　　处：《中华神经医学杂志》2008年第2期170-173,180,共5页Chinese Journal of Neuromedicine

基　　金：广东省医学科研基金（A2004352）

摘　　要：目的探讨急性缺血性脑血管病患者在就诊过程中所出现的院外时间延迟的主要原因。方法对2002年12月-2005年12月期间人住我院神经科的126名急性缺血性脑血管病确诊患者进行调查研究．记录患者基本信息资料及所患疾病基本情况、患者发病时神经功能缺损程度（BI指数）、患者及其看护人卒中常识、基层医疗卫生机构诊治延迟时间、医疗急救系统使用情况、院外延迟时间等。结果急诊人院患者中位就诊延迟时间为5．50h，门诊人院患者中位就诊延迟时间为38．00h。3h内就诊率为26．2％，3—6h内就诊率为7．1％。只有19％的患者使用了120急救电话。Logistic回归分析结果提示：受教育程度（OR=0．466，P=0．039）、BI指数（OR=0．268，P=0．001）、患者对卒中症状的识别（OR=0．225，P=0．040）、基层医院延迟（OR=9．831，P=0．049）等因素与院外延迟具有明显相关性。结论加强对居民的卒中常识宣传教育及社区基层医务人员基本技能培训可以缩短院外延迟时间。Objective To identify the main causes ofpre-hospital delays for the acute ischemic stroke patients. Methods A total of 126 patients （onset age, 35-90 years; average age, 64.97±9.56） diagnosed with acute ischemic stroke were collected and analyzed in our department from December 2002 to December 2005. To record clinical and demographic data, neurological disorder degrees by Barthel Index （BI）, stroke knowledge of the patients and their caregivers if the patients had no conscious disorder, emergency medical system （EMS） usage, delay time of pre-hospital, as well as whether the delay occurred in the community hospital or clinic, exact binary logistic regression was used to predict the delay time. Results For hospitalized patients via emergency department, the median delay time from onset to entering emergency department was about 5.50 h, but for patients via neurology out-patient, the median delay time from onset to entering out-patient department was longer, about 38.00 h. 26.2% patients arrived within 3 h and 7.1% in 3-6 h, only 19.0% activated EMS by calling 120. The binary logistic regression revealed that the most related factors were education （OR=0.466, P=0.039）, BI （OR=0.268, P=0.001）, stroke symptom recognition of patients （OR=0.225, P=0.040）, the delay of the community hospital or clinic（OR=9.831, P=0.049）, and so on. Conclusion Spreading the education of basic stoke knowledge in common people and strengthening the training of basic skills of medical staff in community hospitals or clinics are the critical strategies for shortening the pre-hospital delay in acute ischemic stroke patients.

关 键 词：缺血性卒中 院外延迟 卒中常识教育 社会急救系统 

分 类 号：R743.3[医药卫生—神经病学与精神病学]