紧急医疗救护系统联合静脉溶栓治疗对急性缺血性脑卒中患者预后的影响及院内延迟因素  

Prognostic effect of EMS combined with intravenous thrombolysis on the patients with acute ischemic stroke and the analysis of delayed factors in hospital

作　　者：李百艳[1] 米晓璐 朱保月[1] 王维展[1] 肖青勉[1] Li Baiyan;Mi Xiaolu;Zhu Baoyue;Wang Weizhan;Xiao Qingmian(Emergency Medicine Department,Harrison International Peace Hospital of Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学哈励逊国际和平医院急救医学部,河北衡水053000

出　　处：《中国急救医学》2025年第3期245-250,共6页Chinese Journal of Critical Care Medicine

基　　金：河北省卫生健康委员会科学技术研究与发展计划项目(20200404)。

摘　　要：目的探讨开通紧急医疗救护系统(EMS)联合静脉溶栓治疗对急性缺血性脑卒中(AIS)患者预后影响,并分析发生院内延迟现象的主要环节。方法采用回顾性研究方法,以2019年5月至2023年10月急诊就诊的EMS联合静脉溶栓治疗的AIS患者200例为研究组,另选取2016年1月至2019年4月急诊就诊的接受传统急救流程溶栓的AIS患者200例作为对照组。比较两组住院时间、改良Rankin评分量表(mRS)评分、入院至静脉溶栓时间(DNT)、美国国立卫生研究院卒中量表(NIHSS)评分变化情况、出现不良预后的概率、生存质量变化情况,两种不同入院方式院内诊治环节时间进行比较。结果研究组住院时间、mRS评分、DNT均低于对照组(P<0.05);治疗后2 d、4 d研究组NIHSS评分均低于对照组(P<0.05);研究组出现再发脑出血、再发脑梗死及死亡等不良预后的概率均低于对照组(P<0.05);治疗后研究组生存质量高于对照组(P<0.05)。院内延迟主要环节时间:经EMS入院患者“完成头颅CT扫描-获取CT报告”中位时间23 min高于推荐的20 min(P<0.05),“获取头颅CT报告-开始溶栓治疗”中位时间25 min高于推荐的15 min(P<0.001)。通过EMS就诊患者院内诊治中位时间112 min,短于未经EMS接受溶栓治疗对照组患者的120 min(P<0.05)。结论EMS结合溶栓治疗效果显著,院内救治延迟现象有一定程度的存在,“获取头颅CT报告”到“开始溶栓治疗”这一环节是造成院内延迟的最主要环节。Objective To investigate the effect of emergency medical service(EMS)combined with intravenous thrombolysis on the prognosis of patients with acute ischemic stroke(AIS)and to analyze the main links of in-hospital delay phenomenon.Methods A retrospective research method was adopted.200 AIS patients who received EMS combined with intravenous thrombolysis treatment in the emergency department from May 2019 to October 2023 were selected as the research group.Another 200 AIS patients who received traditional emergency thrombolysis from January 2016 to April 2019 were selected as the control group.The length of hospital stay,modified Rankin scale(mRS),the changes in door-to-needle time(DNT),national institutes of health stroke scale(NIHSS),the probability of adverse prognosis and the changes in quality of life between the two groups were compared.The time of hospital diagnosis and treatment in two different admission methods was compared.Results The length of hospital stay,mRS and DNT of the research group were all lower than those of the control group(P<0.05),the NIHSS of the research group after treatment at the 2 d and 4 d were lower than those control group(P<0.05),and the probability of recurrent cerebral hemorrhage,recurrent cerebral infarction and death were lower in the research group than in the control group(P<0.05).After treatment,the quality of life in the research group was higher than that in the control group(P<0.05).The median time of 23 min for"completion of head CT scan to obtaining CT report"of patients admitted by EMS was higher than the recommended 20 min(P<0.05).The median time of 25 min for"obtaining head CT report-initiating thrombolytic therapy"was higher than the recommended 15 min(P<0.001).The median time of in-hospital diagnosis and treatment in the patients treated by EMS was 112 min,which was shorter than 120 min in the patients treated without EMS(P<0.05).Conclusions EMS combined with thrombolytic therapy has significantly therapeutic effects,and the delay of treatment in hospital is seri

关 键 词：急性缺血性脑卒中 院内延迟 入院至静脉溶栓时间 溶栓 美国国立卫生研究院卒中量表 

分 类 号：R743.3[医药卫生—神经病学与精神病学]