河南省急性脑梗死静脉溶栓现状调查及原因分析  

The current status survey and reasons why acute ischemic stroke patients are treated with thrombolysis in Henan Province

作　　者：赵香梅[1] 杨先芝[1] 李法良[1] 裴小溪[1] 李琳[1] 李玉成[1] 秦历杰[1] 

机构地区：[1]河南省人民医院急诊科,河南郑州450003

出　　处：《中国急救医学》2017年第2期142-144,共3页Chinese Journal of Critical Care Medicine

基　　金：基金项目：国家临床重点专科建设项目（081619232833）;河南省科技厅攻关项目（142102310417）

摘　　要：目的调查河南省急性脑梗死患者溶栓治疗现况并进行原因分析。方法收集我省16家省、市及县医院急性脑梗死患者3120例，分析其诊疗过程。结果3120例患者中省级医院1480例，发病≤4．5h到院226例（15．3％），符合溶栓指征156例，溶栓129例，占23．9％；市级医院910例患者发病4．5h内到医院就诊者230例（25．3％），有溶栓指征189例，溶栓103例，占19．1％，县级医院730例患者中发病4．5h内就诊者245例，有溶栓适应证者195例，溶栓治疗52例，占9．6％。省级医院溶栓率明显高于市级医院，市级医院明显高于县级医院，差异有统计学意义（x2=30．845，P〈0．001；x2=32．514，P〈0．001）。患者〉4．5h就诊时间分布，省级医院明显高于市级医院，市级医院明显高于县级医院，差异均有统计学意义（x2=36．531，P〈0．001；x2=13．520，P〈0．001）。患者发病至首次就诊于省级医院时间明显长于首次就诊于市、县级医院，入院后诊断时间各级医院无明显差异，县级医院患者溶栓决策时间、溶栓前准备时间明显长于省级医院和市级医院（P分别为0．024和0．041）。结论河南省急性脑梗死患者静脉溶栓率偏低，溶栓时间较长，需加强对公众脑卒中知识教育，优化医疗体制及就诊流程，并强化各级医院医师尤其是县级医院溶栓治疗理念并进行相关培训。Objective To investigate the thrombolysis time in patients with acute ischemic stroke（AIS） in Henan Province and discuss the strategies for shortening that period. Methods The clinical data of 3120 AIS patients admitted to 16 hospitals including 1480 cases from provincial hospitals, 910 cases from municipal hospitals and 730 cases from county hospitals in Henan Province were prospectively analyzed. Results Of the 1480 cases came from provincial hospitals, 226 （ 15. 3% ） patients visited hospital within 4. 5 h, in which 156 patients had thrombolysis indications and 129 （23.9%） received thrombolytic therapy. Of the 910 cases from municipal hospitals, 230 （25.3%） patients visited hospital within 4. 5 h, in which 189 patients had thrombolysis indications and 103 （ 19.1% ） received thrombolytic therapy. Of the 730 cases from county hospitals, 245 （ 25.3% ） patients visited hospital within 4.5 h, in which 195 patients had thrombolysis indications and 52（9.6% ） received thrombolytie therapy. Thrombolysis rate in provincial hospitals were higher than that in municipal hospitals, and the same way in municipal hospitals than that in county hospitals （ X2 = 30. 845, P 〈 0.001 ;X2= 32. 514, P 〈 0. 001 ）. Compared to time that patients visited hospital beyond 4.5 h after symptom onset of AIS, the percentage of provincial hospitals was significantly higher than that in municipal and county hospitals （ X2 = 36.531 ,P 〈 0. 001 ;X2 = 13. 520, P 〈 0. 001 ）. Time that patients first visited provincial hospitals was significantly longer than those first visited munieipal and countyhospitals. The diagnosis time between hospitals was almost the same, however, consent provision time, thrombolysis therapy preparation time in county hospitals were longer than that in provincial or municipal hospitals respectively （ P = 0. 024 and P = 0. 041 ） . Conclusion It is urgent to popularize the ischemic stroke knowledge in the public, optimize the health care system and the patient treatment procedu

关 键 词：脑梗死 缺血性脑卒中 组织型纤溶酶原激活物 溶栓治疗 

分 类 号：R743.33[医药卫生—神经病学与精神病学]