结构化院前干预对武汉市某三甲医院急性缺血性脑卒中rt-PA溶栓治疗效果及患者满意度的影响  

Effect of Structured Prehospital Intervention on Efficacy and Satisfaction of rt-PA Thrombolytic Therapy in Patients with Acute Ischemic Stroke in a Grade-A Tertiary Hospital in Wuhan

作　　者：梅俊华[1] 彭敏 王俊力[1] 刘文华 单萍[1] 唐坤[1] 郭章宝[1] 龚雪 陈国华[1] 张鹰[1] MEI Junhua(Department of Neurology,Wuhan First Hospital,Wuhan,Hubei,430022,China)

机构地区：[1]武汉市第一医院神经内科,湖北武汉430022

出　　处：《医学与社会》2023年第10期97-102,114,共7页Medicine and Society

基　　金：武汉市卫生健康委项目,编号为WX20B23。

摘　　要：目的:分析结构化院前干预对急性缺血性脑卒中患者使用rt-PA溶栓的治疗效果及患者满意度的影响,为急性缺血性脑卒中患者使用rt-PA溶栓前进行结构化院前干预提供参考。方法:回顾性分析了武汉市某三甲医院185例经神经科绿色通道收治的发病4.5小时内并接受静脉rt-PA溶栓的急性缺血性脑卒中患者的临床资料。其中干预组98例由采取结构化院前干预措施的急救站转送,未使用结构化院前干预措施的87例为对照组,比较两组疗效、满意度评价及焦虑抑郁量表评分。结果:干预组ODT(175.37±25.01)、DNT(39.07±6.72)、出院NIHSS评分(6.29±3.54)、90天mRS评分(1.18±0.54)与对照组相比存在明显差异(P<0.05)。干预组总体满意度以及服务态度、服务流程、诊疗技术、医患交流、健康教育等维度评分明显高于对照组(P<0.05)。干预组治疗后4周HAMD评分及SDS评分明显低于对照组(P<0.05)。干预组入院24小时以及治疗后2周、4周的HAMA评分和SAS评分明显低于对照组(P<0.05)。结论:对急性缺血性脑卒中rt-PA溶栓患者采取结构化院前干预措施能有效改善疗效及预后,提升患者满意度,降低患者脑卒中相关焦虑抑郁水平,该方式值得在急性脑卒中救治中推广。Objective:To analyze the effect of structured prehospital intervention on the efficacy and satisfaction of patients with rt-PA thrombolysis in acute ischemic stroke,so as to provide references for structured prehospital intervention before thrombolysis with rt-PA in patients with acute ischemic stroke.Methods:The clinical data of patients with acute ischemic stroke who underwent intravenous rt-PA thrombolysis within 4.5 hours treated in the green channel program in the department of neurology in a grade-A tertiary hospital in Wuhan were retrospectively analyzed.The prehospital intervention was conducted at emergency stations where 98 patients were transferred and 87 patients without prehospital intervention were selected in the control group.The efficacy,satisfaction evaluation and anxiety and depression scale of the two groups were compared.Results:Compared with the control group,the ODT(175.37±25.01),the DNT(39.07±6.72),the discharged NIHSS score(6.29±3.54),and the 90-day mRS(1.18±0.54)in the intervention group were significantly different from those in the control group(P<0.05).Compared with the control group,the satisfaction level of the intervention group was significantly higher than that of the control group,and there was a significant difference in the dimensions including service attitude,service process,diagnosis and treatment technology,doctor-patient communication and health education(P<0.05).The intervention group had significantly lower HAMD scores and SDS scores than those in the control group in the four weeks after admission(P<0.05).The HAMA score and SAS score of the intervention group in the 24 hours,two weeks and four weeks after treatment were significantly lower than those of the control group at two weeks and four weeks after treatment(P<0.05).Conclusion:The use of structured prehospital interventions by neurologists for patients with acute ischemic stroke with rt-PA thrombolysis can effectively improve the efficacy and prognosis,improve patient satisfaction,and reduce the level of anxi

关 键 词：医院管理 院前干预 急性缺血性脑卒中 溶栓 治疗效果 患者满意度 

分 类 号：R195.4[医药卫生—卫生统计学]