摘要
目的探索启用院前急救医疗服务(Emergency Medical Services,EMS)转运模式+绿色通道模式在急性缺血性脑卒中救治中的临床价值。方法回顾性分析2022年1月至2024年1月南京市6家医院收治的280例急性缺血性脑卒中患者,根据院前急救方式的不同分为研究组与对照组,每组各140例,研究组患者采用EMS转运联合绿色通道模式,对照组患者则自行入院。比较两组患者组间救治时间、神经功能、自理能力及预后。结果研究组患者的入院时间(Onsetto Door Time,ODT)、入院到CT检查时间(DoortoCT Time,DTC)、入院到静脉溶栓时间(Door to Needle Time,DNT)、发病到溶栓时间(Onset to Needle Time,ONT)均显著短于对照组(P<0.05)。治疗前,两组患者美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分和Barthel指数(Barthel Index,BI)评分均无显著差异(P>0.05);治疗后,两组患者NIHSS评分显著下降、BI评分显著升高,且研究组NIHSS评分下降程度更明显(P<0.001),BI评分上升程度更明显(P<0.001)。随访3个月,通过脑卒中MRS(Modified Rankin Scale,MRS)评分评估分层后发现,研究组中无显著后遗症患者多于对照组(P<0.05);研究组中轻度认知障碍患者少于对照组(P<0.05);两组中明显残疾患者和3个月内死亡患者均无显著差异(P>0.05)。结论EMS转运联合绿色通道模式可有效缩短急性缺血性脑卒中患者的救治时间,减轻患者神经功能损伤程度,提高生活自理能力和溶栓效果,对改善患者预后具有积极作用。
Objective To explore the value of the emergency medical services(EMS)transfer mode+green channel mode in the treatment of acute ischemic stroke.Methods A retrospective analysis of 280 acute ischemic stroke patients admitted to 6 hospitals in Nanjing from January 2022 to January 2024 was conducted.According to the different prehospital emergency medical services methods,they were divided into the study group(EMS transfer joint green channel mode,n=140)and the control group(self-admission,n=140).The treatment time,neurological function,activities of daily living,and prognosis were compared between the two groups.Results The time from onset to admission(ODT),door-to-CT time(DTC),door-to-thrombolysis time(DNT),and onset-to-thrombolysis time(ONT)in the study group were significantly shorter than those in the control group(P<0.05).Before treatment,there was no significant difference in NIHSS score and BI score between the two groups(P>0.05);after treatment,both groups of patients showed a significant decrease in NIHSS scores and a significant increase in BI scores,whilethe decrease in NIHSS score(P<0.001)and the increase in BI score in the study group were more significant than those in the control group(P<0.001).At 3-month follow-up,comparing the MRS scores of the two groups,it was found that the number of patients without significant sequelae in the study group was significantly higher than that in the control group(P<0.05);the number of patients with mild cognitive impairment in the study group was significantly lower than that in the control group(P<0.05);there was no significant difference in the number of patients with severe disability and the number of deaths within 3 months between the two groups(P>0.05).Conclusion The EMS transfer+green channel mode can effectively shorten the treatment time of patients with acute ischemic stroke,reduce the degree of neurological function damage,improve activities of daily living,enhance thrombolysis efficacy,and have a positive effect on improving prognosis.
作者
周国凤
ZHOU Guofeng(Nanjing Emergency Center Emergency Management Department,Nanjing 210000,China)
出处
《中华灾害救援医学》
2024年第6期625-627,637,共4页
Chinese Journal of Disaster Medicine
关键词
急救医学
脑梗死
认知障碍
emergency medicine
brain infarction
cognition disorders
作者简介
通信作者:周国凤,E-mail:1015460960@qq.com。
