基于区域卒中分级诊疗网络救治急性缺血性脑卒中的现状及疗效分析

doi:10.3969/j.issn.1006-7795.2025.01.007

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (1): 41-47.doi: 10.3969/j.issn.1006-7795.2025.01.007

• 国家卫生健康委加强脑卒中防治工作减少百万新发残疾工程 • 上一篇下一篇

基于区域卒中分级诊疗网络救治急性缺血性脑卒中的现状及疗效分析

詹艳丽¹, 李一吟², 李平¹, 孙景萍³, 黄良通³, 蔡学礼^1，3*

1.丽水市中心医院心脑血管病防治中心，浙江丽水 323000；2.遂昌县人民医院神经内科，浙江遂昌 323300；3.丽水市中心医院脑神经内科，浙江丽水 323000

收稿日期:2024-09-23 出版日期:2025-02-21 发布日期:2025-02-24
通讯作者: 蔡学礼 E-mail:xueli_cai_official@126.com
基金资助:
中国脑卒中高危人群干预适宜技术研究及推广项目（GN-2020-R0009）,浙江省医药卫生科技计划项目（2023XY259）。

Analysis of the current status and efficacy of acute ischemic stroke treatment based on hierarchical medical service network

Zhan Yanli¹，Li Yiyin²，Li Ping¹，Sun Jingping³，Huang Liangtong³，Cai Xueli^1,3*

1.Cardiovascular & Cerebrovascular Diseases Control Centre，Lishui Central Hospital，Lishui 323000，Zhejiang Province，China；2.Department of Neurology，People's Hospital of Suichang County ，Suichang 323300，Zhejiang Province，China；3.Department of Neurology，Lishui Central Hospital，Lishui 323000，Zhejiang Province，China

Received:2024-09-23 Online:2025-02-21 Published:2025-02-24
Supported by:
This study was supported by Research and Promotion of Appropriate Technology for Stroke Intervention in High-risk Groups in China (GN-2020-R0009)， Zhejiang Medical and Health Technology Project (2023XY259).

摘要/Abstract

摘要： 目的分析区域卒中分级诊疗网络卒中救治现状及转诊对患者预后的影响，优化卒中救治模式，提高卒中救治效率。方法选择浙江省丽水地区2020年1月至2022年12月经区域卒中分级诊疗网络转诊的急性缺血性脑卒中（acute ischemic stroke，AIS）患者573例，分析救治情况及临床资料，依据是否在三级卒中中心行血管内治疗分为有效转诊组（261例）和无效转诊组（312例）。比较两组患者的人口学资料、危险因素、临床特征、实验室检查等，分析两组的差异性指标，同时评估两组患者的预后情况。结果 573例患者中接受静脉溶栓治疗者197例，血管内治疗者261例,有效转诊率为45.55%（261/573）。有效转诊组患者与无效转诊组患者的人口学资料如性别、年龄、体质量指数（body mass index，BMI），危险因素如高血压、糖尿病、血脂异常、卒中及吸烟饮酒等情况差异均无统计学意义。有效转诊组冠状动脉粥样硬化性心脏病及房颤病史的比例更高（χ²=5.34、8.67，P＜0.05），更容易表现为凝视、构音障碍、意识障碍等症状（χ²=130.1、22.12、22.96，P ＜0.05），入院基线美国国立卫生研究院卒中量表( National Institutes of Health Stroke Scale, NIHSS) 评分更高（F =3.25，P ＜0.05）。比较两组患者入院时血细胞参数显示，有效转诊组嗜酸性粒细胞计数、嗜碱性粒细胞计数、淋巴细胞计数更低（Z=－8.86、－5.39,F=0.598，P ＜0.05）。分析两组患者的预后情况，有效转诊组改良 Rankin 量表( modified Rankin Scale,mRS) 评分随时间的推移下降更加明显。二元 Logistic 回归分析显示，基线NIHSS评分（OR=1.122, 95% CI:1.074～1.172)、嗜酸性粒细胞（OR=0.085, 95% CI:0.013～0.564)、中性粒细胞计数（OR=1.088, 95% CI:1.011～1.172)为有效转诊的独立影响因素。结论现阶段实施的区域卒中分级诊疗网络救治效率有待进一步提高，有效转诊有助于改善患者的短期预后，开发包含人口学特征、危险因素、症状体征、实验室检查等指标在内的预测模型帮助基层医务人员快速识别大血管闭塞可能有助于提高AIS的救治效率。

关键词: 急性缺血性脑卒中, 分级诊疗, 大血管闭塞

Abstract: Objective To analyze the current status of stroke treatment in the hierarchical medical service network and the impact of referral on prognosis, to optimize the stroke treatment models, and to improve stroke treatment efficiency. Methods Totally 573 patients with acute ischemic stroke who were referred by the hierarchical medical service network in Lishui, Zhejiang Province from January 2020 to December 2022 were selected for analysis of treatment and clinical data. Based on whether they received endovascular treatment at a high-level stroke center, they were divided into an effective referral group (261 cases) and an ineffective referral group (312 cases). Demographic data, influencing factors, clinical characteristics, and laboratory tests were compared between the two groups, and the differences were analyzed by using single-factor analysis, and prognosis of the two groups of patients was assessed. Results Among 573 patients,197 received intravenous thrombolytic therapy and 261 received intravascular therapy. The effective referral rate was 45.55%. The proportion of patients in the effective referral group coronary artery disease and atrial fibrillation proportion is higher（χ²=5.34,8.67，P＜0.05), more likely to show dysarthria, gaze, and consciousness disorder（χ²=130.1,22.12,22.96，P ＜0.05), and the baseline NIHSS score was higher (F =3.25，P ＜0.05). Comparing the baseline blood cells counts of the two groups of patients at admission, the effective referral group showed lower eosinophil count, basophil count and lymphocyte (Z=－8.86,－5.39,F=0.598，P ＜0.05). As for the prognosis, the proportion of neurological function improvement at discharge in the effective referral group was higher than that in the ineffective referral group. Binary Logistic regression analysis showed that baseline NIHSS score (OR=1.122, 95% CI:1.074-1.172), eosinophil (OR=0.085, 95% CI:0.013-0.564), and neutrophil count (OR=1.088, 95% CI:1.011-1.172) were independent influencing factors for effective referrals. Conclusions The efficiency of the current regional stroke classification and treatment network needs to be further improved. Developing predictive models that include demographic characteristics, risk factors, symptoms, signs, and laboratory tests may help medical staff in stroke prevention and treatment centers quickly identify large vessel occlusion and improve acute ischemic stroke treatment efficiency.

Key words: acute ischemic stroke, hierarchical medical system, large vessel occlusion

中图分类号:

R743.3

詹艳丽, 李一吟, 李平, 孙景萍, 黄良通, 蔡学礼. 基于区域卒中分级诊疗网络救治急性缺血性脑卒中的现状及疗效分析[J]. 首都医科大学学报, 2025, 46(1): 41-47.

Zhan Yanli, Li Yiyin, Li Ping, Sun Jingping, Huang Liangtong, Cai Xueli. Analysis of the current status and efficacy of acute ischemic stroke treatment based on hierarchical medical service network[J]. Journal of Capital Medical University, 2025, 46(1): 41-47.

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基于区域卒中分级诊疗网络救治急性缺血性脑卒中的现状及疗效分析

Analysis of the current status and efficacy of acute ischemic stroke treatment based on hierarchical medical service network

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