局域性脑卒中中心网络的建设对提高区域内急性缺血性脑卒中救治能力的作用  

Role of construction of regional stroke center network in improving treatment capacity for acute ischemic stroke in the region

作　　者：李先锋 周凤坤 陈子龙 苏宇 谭凯文 卢春辉 陆岸英 韦金儒[1] LI Xian-feng;ZHOU Feng-kun;CHEN Zi-long;SU Yu;TAN Kai-wen;LU Chun-hui;LU An-ying;WEI Jin-ru(Department of Neurology Ward 2,the Fifth Affiliated Hospital of Guangxi Medical University&the First People′s Hospital of Nanning,Nanning 530022,China;Department of Neurology,Nanning Hospital of Traditional Chinese Medicine,Nanning 530023,China;Department of Neurology,the People′s Hospital of Binyang County,Nanning 530000,China;Department of Neurology,Binyang Hospital of Traditional Chinese Medicine,Nanning 530000,China)

机构地区：[1]广西医科大学第五附属医院暨南宁市第一人民医院神经内科二区,南宁市530022 [2]广西南宁市中医医院神经内科,南宁市530023 [3]广西南宁市宾阳县人民医院神经内科,南宁市530000 [4]广西南宁市宾阳县中医医院神经内科,南宁市530000

出　　处：《广西医学》2020年第17期2269-2273,共5页Guangxi Medical Journal

基　　金：广西南宁市科学研究与技术开发计划(20163142);广西医药卫生科研课题(Z20180671);广西南宁市青秀区科技计划(2018028)。

摘　　要：目的探讨局域性脑卒中中心网络的建设对提高区域内急性缺血性脑卒中救治能力的作用。方法由南宁市第一人民医院牵头成立“南宁市脑卒中中心网络”,收集脑卒中中心网络运行前及运行后在各分中心医院就诊的急性缺血性脑卒中患者资料。比较运行前后急救网络的救治人数、院前延误率、院内延误率及在综合卒中中心进行静脉溶栓患者的美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分量表评分、出血转化率等。结果(1)脑卒中中心网络运行后,区域内快速转运、静脉溶栓、血管内治疗的患者例数均较运行前增长。(2)脑卒中中心网络运行后,区域内综合卒中中心及分中心急性缺血性卒中患者院前及院内延误率均较脑卒中中心网络运行前降低(P<0.05)。(3)与脑卒中中心网络运行前比较,脑卒中中心网络运行后综合卒中中心静脉溶栓患者的静脉溶栓率增加、入院至溶栓时间缩短、溶栓后1 d及90 d的NIHSS评分降低、神经功能良好率提高、出血转化率降低(均P<0.05)。结论局域性脑卒中中心网络的建立,提高了区域内卒中的救治能力,值得推广。Objective To explore the role of the construction of regional stroke center network in improving treatment capability for acute ischemic stroke in the region.Methods The Nanning Stroke Center Network,headed by the First People′s Hospital of Nanning,was developed,the data of patients with acute ischemic stroke visiting sub-center hospitals were collected before and after running the stroke center network.The relevant indices before and after running the first aid network were compared,including number of patients rescued,rate of pre-hospital care delay,rate of in-hospital care delay,as well as the National Institutes of Health Stroke Scale(NIHSS)scores,modified Rankin Scale scores,bleeding conversion rate and other indices of patients undergoing intravenous thrombolysis in the comprehensive stroke centers.Results(1)After the operation of the stroke center network,the number of patients receiving rapid transport,intravenous thrombolysis,or intravascular treatment in the region was increased as compared with that before the operation.(2)After the operation of the stroke center network,the pre-hospital and in-hospital care delay rates of patients with acute ischemic stroke in the regional comprehensive stroke centers and sub-centers were lower than those before the operation of the stroke center network(P<0.05).(3)Compared with those before the operation of the stroke center network,in the comprehensive stroke centers,increased intravenous thrombolysis rate,decreased door to needle time,lower NIHSS scores one and 90 days after thrombolysis,elevated rate of good neurological function,and reduced bleeding conversion rate were observed in patients with intravenous thrombolysis after the operation of the stroke center network(all P<0.05).Conclusion The construction of the regional stroke center network can improve stroke treatment capacity in the region,and it is worthy of promotion.

关 键 词：急性缺血性脑卒中 脑卒中中心网络 静脉溶栓 院前延误 院内延误 

分 类 号：R743.3[医药卫生—神经病学与精神病学]