缺血性脑卒中患者血管内治疗院内延迟现状及对策研究  

Current Situation and Countermeasures of In- hospital Delay of Endovascular Treatment for Patients With Ischemic Stroke

作　　者：赵艺皓 杨莘[2] 苏林霞 黄弢[4] 郎野[4] 杨晓燕[4] 李晓花[5] 范玉龙 吉训明[7] 

机构地区：[1]首都医科大学卫生管理与教育学院,北京市100069 [2]首都医科大学宣武医院护理部 [3]山东大学齐鲁医院神经内科 [4]首都医科大学科研处 [5]首都医科大学宣武医院神经内科 [6]北京清华长庚医院神经外科 [7]首都医科大学宣武医院神经外科

出　　处：《中国全科医学》2016年第19期2279-2283,共5页Chinese General Practice

基　　金：首都市民健康项目培育(Z151100003915088)

摘　　要：背景对急性缺血性脑卒中的适宜患者采取血管内治疗具有临床疗效,但这一治疗方法受时间窗限制。目的通过对缺血性脑卒中患者血管内治疗流程现状进行调查,分析产生院内延迟的原因,以提出相应的解决措施。方法采用自行设计的《某三甲医院缺血性脑卒中血管内治疗流程调查表》,对2014年11月—2015年4月在某三甲医院接受血管内治疗的缺血性脑卒中患者32例进行跟踪调查,内容包括患者的一般资料、临床特征、到达急诊-开始股动脉穿刺的各环节时间及流程中影响院内总时间关键事件的记录。结果 32例患者到达急诊-开始股动脉穿刺的平均时间为(171.8±52.5)min,与90 min的国际标准时间比较差异有统计学意义(P<0.05)。其中首先呼叫动脉溶栓组医师与首先呼叫静脉溶栓组医师患者到达急诊-获得动脉溶栓组医师会诊的平均时间分别为(11.7±6.8)、(66.9±53.2)min,到达急诊-开始股动脉穿刺的平均时间分别为(143.9±26.1)、(199.6±58.0)min;在CT之前进行心电图检查与在CT之后进行心电图检查患者到达急诊-到达CT室的平均时间分别为(63.1±47.3)、(31.9±12.3)min。结论缺血性脑卒中患者血管内治疗院内延迟现象严重,医院应完善脑卒中组织化管理的相关政策与制度,不断改进绿色通道质量控制机制,以缩短院内延迟时间。Background Endovascular treatment has demonstrated clinical efficacy in selected patients with acute ischemic stroke, but it is limited by the time window. Objective To investigate the present situation of endovaseular treatment process received by ischemic stroke patients and analyze the reasons of in - hospital delay, in order to propose countermeasures. Methods A self - designed questionnaire about the endovascular procedures for stroke in a third - class grade -one hospital was employed. From November 2014 to April 2015, we conducted follow - up surveys on 32 ischemic stroke patients who received endovascular treatment in a third - class grade - one hospital, and the survey content included general data, clinical features, time of each link between the arrival at emergency department and the start of femoral artery puncture, and key events influencing the total hospitalized time during the whole process. Results The average time between the arrival at emergency department and the start of femoral artery puncture of the 32 patients was （171.8 ± 52. 5） minutes, which was significantly different from 90 minutes, the international standard time （ P 〈 0.05 ） . For patients who called doctors of artery thrombolysis group first and patients who called doctors of intravenous thrombolysis group first, the mean time between the arrival at emergency department and the consultation of physicians in artery thrombolysis group was （ 11.7 ± 6. 8 ） and （ 66. 9 ±53.2 ） minutes respectively, and the mean time between the arrival at emergency department and the start of femoral artery puncture was （ 143.9 ±26. 1 ） minutes and （ 199. 6±58.0） minutes respectively. The mean time between the arrival at emergency department and the arrival at CT room for patients who received electrocardiography before CT and ＇after CT was （ 63. 1 ± 47.3 ） and （ 31.9 ± 12.3 ） minutes respectively. Conclusion The present situation of in - hospital delay is serious. The hospital should improve the policies and

关 键 词：脑缺血 卒中 血管内治疗 院内延迟 

分 类 号：R743[医药卫生—神经病学与精神病学]