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| 我国三级甲等医院急性缺血性脑卒中院前预警与院内绿色通道流程管理现况调查 |
| 张小曦1,周一汉1,李群2,李密2,李子付1,张磊1,沈红健1,张永巍1,杨鹏飞1*,刘建民1 |
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(1. 海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433;
2. 海军军医大学(第二军医大学)教务处, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 通过对全国三级甲等医院神经介入医师进行调研，了解我国不同行政区域三级甲等医院急性缺血性脑卒中患者院前预警与院内绿色通道流程管理的现况及同质性。方法 采用便利抽样法，通过问卷星微信小程序、邮件等方式向我国脑血管病介入治疗领域的专家发放ALICE调查问卷（中文版脑血管病血管内治疗现状问卷调查-ALICE研究），调查内容包括医院基本信息、脑血管病（急性缺血性脑卒中、颅内动脉瘤、动静脉畸形、非狭窄性颈动脉斑块）治疗现况、患者转运制度等，并分析不同行政区域（华北、东北、华东、华中、华南、西南、西北七大行政区）的绿色道管流程通理现状及不同优化管理策略所能节省的入院至治疗时间。结果 共发放问卷142份，剔除内容不完整的问卷11份，回收有效问卷131份。131名神经介入医师来自126家医院，所有医院均为三级甲等医院。126家医院中，年机械取栓治疗例数>100例的医院占31.0%（39/126），救护车直接入院是急诊急性缺血性脑卒中患者的主要收治方式[53%（35%，70%）]。不同行政区域医院的院前预警机制、急诊预检、CT机与导管室空间布局、常规麻醉方案、机械取栓准备均存在轻度差异，但差异均无统计学意义（P均>0.05）。麻醉医师全天处于可呼叫状态、优化影像学检查流程、CT机位置优化或功能整合、提前预警机制分别可缩短入院至治疗时间21（19，30）、20（15，30）、20（12，25）、19（10，23）min。结论 我国不同行政区域三级甲等医院之间急性缺血性脑卒中院内绿色通道救治流程的同质性较高。避免非必要步骤、规划合理的卒中绿色通道及采用并联化管理可极大提高救治效率。 |
| 关键词: 急性缺血性脑卒中 院前预警 院前急救 绿色通道 流程管理 卒中中心 |
| DOI：10.16781/j.0258-879x.2022.01.0015 |
| 投稿时间：2021-09-20 |
| 基金项目:上海市扬帆计划（20YF1448000），上海市临床重点专科项目（shslczdzk06101），海军军医大学（第二军医大学）长海医院青年启动基金（2018QNA007），上海申康医院发展中心临床研究关键支撑项目（SHDC2020CR6014） |
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| Pre-hospital warning and in-hospital green channel process management of acute ischemic stroke in tertiary first-class hospitals in China: a cross-sectional study |
| ZHANG Xiao-xi1,ZHOU Yi-han1,LI Qun2,LI Mi2,LI Zi-fu1,ZHANG Lei1,SHEN Hong-jian1,ZHANG Yong-wei1,YANG Peng-fei1*,LIU Jian-min1 |
(1. Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Office of Teaching Affairs, Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the status and homogeneity of pre-hospital warning and in-hospital green channel process management of patients with acute ischemic stroke in tertiary first-class hospitals in different administrative regions of China.Methods Convenience sampling method was conducted among experts in the field of interventional therapy of cerebrovascular diseases in China. Then, the ALICE questionnaire (Chinese version of questionnaire on the status of intravascular treatment of cerebrovascular diseases-ALICE study) was sent to them by WeChat Mini Program (the online survey tool Sojump) or e-mail. The survey contents included the basic information of the hospital, the treatment status of cerebrovascular diseases (acute ischemic stroke, intracranial aneurysm, arteriovenous malformation and non-stenotic carotid plaque) and patient transfer system. The status of green channel process management in 7 administrative regions (North, Northeast, East, Central, South, Southwest and Northwest) of China and the saved time of door-to-treatment after optimizing the management strategies were analyzed.Results A total of 142 questionnaires were distributed, 11 incomplete questionnaires were excluded, and 131 valid questionnaires were collected. The 131 neurointerventional physicians were from 126 tertiary first-class hospitals. Hospitals with more than 100 cases of mechanical thrombectomy every year accounted for 31.0% (39/126). Direct admission by ambulance was the main mode of care for emergency acute ischemic stroke patients (53%[35%, 70%]). There were slight differences in the pre-hospital warning mechanism, emergency pre-examination, space layout between CT machine and catheter operation room, general anesthesia protocol and preparation for mechanical thrombectomy among the hospitals in different administrative regions, showing no significant differences (all P > 0.05). Anesthesiologists in a callable state throughout the day, optimization of the imaging procedure, position optimization or functional integration of CT machine and advance warning mechanism could shorten the time of door-to-treatment by 21 (19, 30), 20 (15, 30), 20 (12, 25) and 19 (10, 23) min, respectively.Conclusion There is a high homogeneity of in-hospital green channel treatment process for acute ischemic stroke among the tertiary first-class hospitals in different administrative regions of China. Avoiding unnecessary steps, planning a reasonable stroke green channel and parallel-management can greatly improve the rescue and treatment efficiency. |
| Key words: acute ischemic stroke pre-hospital warning pre-hospital rescue green channel process management stroke center |
