双重差异模型下改良JUST评分用于急性脑卒中患者院前管理的效能  

An analysis of the efficacy of a modified JUST score for the pre-hospital management of acute stroke patients based on differences-in-differences model

作　　者：唐晓蕾 魏薇萍[1] 管佳慧[1] Tang Xiaolei;Wei Weiping;Guan Jiahui(Emergency Department,Shanghai Sixth People′s Hospital,Shanghai 200233,China)

机构地区：[1]上海市第六人民医院急诊医学科,上海200233

出　　处：《中国急救医学》2023年第7期557-562,共6页Chinese Journal of Critical Care Medicine

基　　金：上海市第六人民医院院级科学研究基金(x院内-2496)。

摘　　要：目的探究双重差异模型(differences-in-differences,DID)下改良的日本急性卒中分类(Japan urgent stroke triage,JUST)评分对急性脑卒中患者院前管理效能。方法选择2020年1月至2022年10月上海第六人民医院急诊科抢救室收治的215例急性脑卒中患者作为研究对象,2020年1月至2021年5月接诊的患者作为对照组(n=106)并给予传统救护模式,2021年6月至2022年10月接诊的患者作为观察组(n=109)并给予院前院内协同救治平台模式。比较两组急诊抢救成功率、住院病死率、病残率、院内抢救时效指标(救治时间、术前准备时间、建立高级气道、静脉通路时间)、干预前后不同时间点(干预前及干预结束后2、4、6、8周)神经功能恢复情况及并发症发生情况,同时采用DID模型对比两组各时间点神经功能以评估干预效果。结果干预结束后,两组急诊抢救成功率、住院病死率、病残率差异有统计学意义(P<0.05),其中观察组抢救成功率(90.83%)明显高于对照组(χ^(2)=4.928,P=0.026),住院病死率(9.17%)及病残率(26.61%)明显低于对照组(χ^(2)=4.928,P=0.026;χ^(2)=8.155,P=0.004)。两组各项院内抢救时效指标差异有统计学意义,其中观察组的救治时间[(2.22±0.97)h]、术前准备时间[(18.06±5.43)min]、建立高级气道[(15.25±4.39)min]、静脉通路时间[(7.41±2.35)min]明显短于对照组(P均<0.05)。干预前两组神经功能评分差异无统计学意义(t=0.236,P=0.814),干预后两组神经功能评分均下降(P值均<0.05),干预结束后2、4、6、8周观察组神经功能评分[2周:(9.25±2.18)分;4周:(8.11±2.19)分;6周:(6.50±1.62)分;8周:(5.29±0.99)分]均明显低于对照组(P均<0.05)。干预结束后观察组并发症总发生率为11.93%,明显低于对照组27.36%(P<0.05)。结论改良JUST评分应用于急性脑卒中患者院前管理可提高急诊抢救成功率,减少患者病残或病死率,为院内抢救争取有效时间,还可减少患者并发症发�Objective To investigate the effectiveness of the modified Japan urgent stroke triage(JUST)score in the pre-hospital management of acute stroke patients based on the differences-in-differences(DID)model.Methods From January 2020 to October 2022,215 acute stroke patients admitted to the emergency department of the Sixth People′s Hospital in Shanghai were selected for the research objects.Patients from January 2020 to May 2021 were treated as the control group(n=106)and given the traditional ambulance model,while the patients from June 2021 to October 2022 were treated as the observation group(n=109)and given the pre-hospital and in-hospital collaborative care platform model.The success rate of emergency resuscitation,in-hospital mortality rate,disability rate,in-hospital resuscitation time indicators(rescue time,preoperative preparation time,time to establish advanced airway,intravenous access),neurological recovery at different time points(before intervention and 2,4,6 and 8 weeks after the end of the intervention)and complications were compared between the two groups,and the DID model was used to compare the neurological function of the two groups at each time point to assess the intervention effect.Results At the end of the intervention,there were statistical differences in the emergency resuscitation success rate,in-hospital mortality rate and disability rate between the two groups(P<0.05),and the observation group had a significantly higher resuscitation success rate(90.83%,χ^(2)=4.928,P=0.026)and a significantly lower in-hospital mortality(9.17%,χ^(2)=4.928,P=0.026)and disability rate(26.61%,χ^(2)=8.155,P=0.004)than the control group.There were statistical differences in various in-hospital resuscitation time indicators between the two groups,and the observation group had significantly shorter rescue time[(2.22±0.97)h],preoperative preparation time[(18.06±5.43)min],the establishment of advanced airway[(15.25±4.39)min]and intravenous access time[(7.41±2.35)min]than the control group(P<0.05).Before in

关 键 词：双重差异模型(DID) 急性脑卒中 神经功能评分 病残率 预后 日本急性卒中分类(JUST)评分 并发症 美国国立卫生研究院率中量表(NIHSS) 

分 类 号：R743.3[医药卫生—神经病学与精神病学]