急性缺血性脑卒中患者卒中认知调查及延迟就诊相关因素分析

摘要
图/表
参考文献(23)
相关文章 (9)

全文: PDF (0 KB) HTML (65 KB)
输出: BibTeX | EndNote (RIS)

摘要目的调查急性缺血性脑卒中患者对卒中危险因素及症状的认知情况及影响就诊时间的可能因素。方法2014年1月～2015年6月，使用结构式问卷前瞻性调查急性缺血性脑卒中患者对脑卒中知识的认知情况和发病后就医过程各阶段的时间，分析就诊时间与其人口社会学资料、既往病史、发病时状态、发病后采取措施、首发症状、神经功能缺损程度和卒中认知之间的关系，运用多元线性回归分析方法筛选影响就诊时间的相关因素。结果共纳入133例就诊于兰州大学第一医院神经内科的急性缺血性脑卒中病例，发病年龄为（63.20±11.46）岁，男性86例（64.7%）。认知率最高的急性缺血性脑卒中危险因素是高血压（66.2%），认知率最高的急性缺血性脑卒中症状是肢体无力（59.4%）。24.1%的调查对象能识别4个以上卒中危险因素，15.0%能识别3个以上卒中症状，再次住院组能识别4个以上卒中危险因素（P=0.021）和3个以上卒中症状（P=0.044）所占比例显著高于首次住院组。就诊总时间（ONT）为（2327.27±2157.30）min，中位数为1440.00 min；平均院前时间（ODT）为1352.89（10.00～8730.00）min，中位数为400.00 min；平均院内时间（DNT）为641.16（8.00～5760.00）min，中位数为360.00 min，急诊入院组的ONT（P=0.000）、ODT（P=0.000）明显短于门诊入院组。多元线性回归分析显示，年龄段（P=0.082）、居住状态（P=0.061）、首发头晕症状（P=0.017）、发病后采取措施（P=0.053）和对溶栓治疗时间窗的认知（P=0.090）与ONT显著相关，年龄偏大、独居、无首发头晕症状、发病后未拨打急救电话及不知道溶栓治疗时间窗提示ONT延长。结论就诊于我院神经内科的急性缺血性脑卒中患者普遍存在就诊延迟现象，存在年龄偏大、独居、无首发头晕症状、发病后未拨打急救电话及不知道溶栓治疗时间窗时提示就诊延迟。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈小明
	陈晋莉
	叶小祥
	鲁雅琴
	刻宁

关键词 ：急性缺血性脑卒中, 卒中认知, 就诊延迟, 多元线性回归分析

Abstract：Objective To investigate the cognition of risk factors and symptoms of stroke for patients with acute ischemic stroke on and potential factors affecting visit time.Methods From January 2014 to June 2015，a prospective survey using structured questionnaire for patients with acute ischemic stroke was conducted to investigate the cognition of stroke knowledge and the time of each stage of the medical treatment after the onset of the disease.The relations between visit time and sociology data of population，past medical history，state of onset，measures taken at onset of disease，the first-episode symptoms，the defect degree of neural function，cognition of stroke was analyzed respectively.The related factors affecting visit time were screened by multiple linear regression analysis method.Results 133 patients with acute ischemic stroke received by department of neurology in the First Hospital of Lanzhou University were enrolled，age of onset was (63.20±11.46) years old，86 cases (64.7%) were male.The risk factor of acute ischemic stroke with highest cognitive rate was hypertension (66.2%)，the symptom of acute ischemic stroke with highest cognitive rate was limb weakness (59.4%).24.1% of patients could recognize more than 4 risk factors of stroke and 15% of them could recognize more than 3 symptoms ofstroke.Proportion of could recognize more than 4 risk factors (P=0.021) and more than 3 symptoms (P=0.044) of stroke in rehospitalization group was obviously higher than that of first hospitalization group respectively.The onset-to-needle time (ONT) was (2327.27±2157.30) min，with a median was 1440.00 min.The average onset-to-door time (ODT) was 1352.89 (10.00-8730.00) min，with a median was 400.00 min.The average door-to-needle time (DNT) was 641.16 (8.00-5760.00) min，with a median was 360.00 min.The ONT (P=0.000) and ODT (P=0.000) in the emergency hospitalization group was significantly shorter than that in the clinic hospitalization group.Multiple linear regression analysis showed age bracket (P=0.082)，housing state (P=0.061)，first-episode dizziness symptom (P=0.017)，measures taken at onset of disease (P=0.053)，cognition of time window for thrombolytic therapy (P=0.090) was significantly associated with ONT respectively，and elder age，living alone，had no first-episode dizziness symptom，no emergency call after onset of disease and ignorance of time window of thrombolytic therapy indicated that extension of ONT.Conclusion Delayed treatment phenomenon is generally exist in patients with acute ischemic stroke received by department of neurology in our hospital，when exsits older age，living alone，had no first-episode dizziness symptom，no emergency call after onset of disease and ignorance of time window of thrombolytic therapy，and it indicates that extension of ONT.

Key words： Acute ischemic stroke Stroke cognition Delayed treatment Multiple linear regression analysis

通讯作者: 刘宁（1957-），女，甘肃兰州人，教授，硕士生导师，主任医师，以脑血管病、神经变性疾病及癫痫为研究方向

作者简介: 陈小明（1991-），男，甘肃陇南人，2013级在读硕士研究生，以脑血管病为主要研究方向

引用本文:

陈小明;陈晋莉;叶小祥;鲁雅琴;刻宁. 急性缺血性脑卒中患者卒中认知调查及延迟就诊相关因素分析[J]. 中国当代医药, 2016, 23(3): 4-10.
CHEN Xiao-ming;CHEN Jin-li;YE Xiao-xiang;LU Ya-qin;LIU Ning. Cognitive investigation and relative factors analysis on delayed treatment for patients with acute ischemic stroke. 中国当代医药, 2016, 23(3): 4-10.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2016/V23/I3/4

[1]	Mikulik R，Wahlgren N.Treatment of acute stroke：an update[J].J Intern Med，2015，278（2）：145-165.
[2]	Caruso D，Perez Akly M，Costantini PD，et al.Do elderly patients call 911 when presented with clinical scenarios suggestive of acute stroke? A cross-sectional study[J].Cerebrovasc Dis，2015，39（2）：87-93.
[3]	Wang X，Wang Y，Wang C，et al.Association between estimated glomerular filtration rate and clinical outcomes in patients with acute ischaemic stroke：results from China National Stroke Registry[J].Age Ageing，2014，43（6）：839-845.
[4]	Sun H，Zou X，Liu L.Epidemiological factors of stroke：a survey of the current status in China[J].J Stroke，2013，15（2）：109-114.
[5]	Jauch EC，Saver JL，Adams HP Jr，et al.Guidelines for the early management of patients with acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke，2013，44（3）：870-947.
[6]	Powers WJ，Derdeyn CP，Biller J，et al.2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke，2015，46（10）：3020-3035.
[7]	Prabhakaran S，Ward E，John S，et al.Transfer delay is a major factor limiting the use of intra-arterial treatment in acute ischemic stroke[J].Stroke，2011，42（6）：1626-1630.
[8]	Mellon L，Doyle F，Rohde D，et al.Stroke warning campaigns：delivering better patient outcomes? A systematic review[J].Patient Relat Outcome Meas，2015，6：61-73.
[9]	Grady A，Carey M，Sanson-fisher R.Assessing awareness of appropriate responses to symptoms of stroke[J].Patient Educ Couns，2014，95（3）：400-405.
[10]	Faiz KW，Sundseth A，Thommessen B，et al.Reasons for low thrombolysis rate in a Norwegian ischemic stroke population[J].Neurol Sci，2014，35（12）：1977-1982.
[11]	章娟.卒中急救的科学计量分析与时间延迟的调查研究[D].武汉：华中科技大学，2012.
[12]	Wireklint sundstrom B，Herlitz J，Hansson PO，et al.Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke：results of an observational study[J].BMJ Open，2015，5（9）：e008228.
[13]	Yang J，Zheng M，Cheng S，et al.Knowledge of stroke symptoms and treatment among community residents in Western Urban China[J].J Stroke Cerebrovasc Dis，2014，23（5）：1216-1224.
[14]	陈荣波，许伟雄，詹俊青，等.脑梗死患者就诊延迟的影响因素分析[J].中国实用神经疾病杂志，2013，16（9）：1-3.
[15]	Bamford J，Sandercock P，Dennis M，et al.Classification and natural history of clinically identifiable subtypes of cerebral infarction[J].Lancet，1991，337（8756）：1521-1526.
[16]	Jin H，Zhu S，Wei JW，et al.Factors associated with prehospital delays in the presentation of acute stroke in urban China[J].Stroke，2012，43（2）：362-370.
[17]	Fonarow GC，Reeves MJ，Smith EE，et al.Characteristics，performance measures，and in-hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelines-stroke[J].Circ Cardiovasc Qual Outcomes，2010，3（3）：291-302.
[18]	Ragoschke-Schumm A，Walter S，Haass A，et al.Translation of the 'time is brain' concept into clinical practice：focus on prehospital stroke management[J].Int J Stroke，2014，9（3）：333-340.
[19]	Chen CH，Huang P，Yang YH，et al.Pre-hospital and inhospital delays after onset of acute ischemic stroke：a hospital-based study in southern Taiwan[J].Kaohsiung J Med Sci，2007，23（11）：552-559.
[20]	Kurz MW，Kurz KD，Farbu E.Acute ischemic stroke—from symptom recognition to thrombolysis[J].Acta Neurol Scand Suppl，2013，（196）：57-64.
[21]	Faiz KW，Sundseth A，Thommessen B，et al.Factors related to decision delay in acute stroke[J].J Stroke Cerebrovasc Dis，2014，23（3）：534-539.
[22]	王亚冰，焦力群，王亚东，等.北京市三甲医院急性脑血管病患者发病至治疗延迟时间分布[J].中国神经精神疾病杂志，2009，35（1）：22-25.
[23]	Skolarus LE，Scott PA，Burke JF，et al.Antihypertensive treatment prolongs tissue plasminogen activator door-totreatment time：secondary analysis of the INSTINCT trial[J].Stroke，2012，43（12）：3392-3394.