Stroke:院前检测大血管闭塞的分流量表对资源利用率和治疗时间的影响!

2017-12-30 xing.T MedSci原创

由此可见,基于卒中严重程度量表的院前分诊策略会对病人的流动和分布产生交大的影响。LVO患者早期取栓术的益处可能大于某些无LVO的患者延迟溶栓治疗相关的危害。进一步进行临床卒中严重程度量表作为分流工具的随机试验是很有必要的,以确认该研究的结果。

院前卒中严重程度量表可以帮助分拣大血管闭塞(LVO)的急性缺血性脑卒中患者,从而将其直接转入综合性卒中中心。其对资源的使用和伴有和不伴有LVO的患者再灌注治疗时间的影响是未知的。近日,卒中领域权威杂志Stroke上针对这一问题发表了一篇研究文章。

基于卒中症状的严重程度的经验分布、院前延迟时间和卒中症状严重程度相关的LVO可能性,研究人员模拟院前发生的卒中样症状简要地理环境来估计基于不同临界值的快速动脉闭塞的评价量表的院前分流策略的影响。

与将患者运送到最近的卒中中心相比,基于快速动脉闭塞的评价量表的临界值评分≥5的院前分流策略实施后被送往综合性卒中中心的疑似卒中患者增多,而被送往初级卒中中心的患者减少(分别为+11.7%[95%可信区间:+ 8.1%至+15.3%]和−18.4%[-19.1%至-17.7%])。腹股沟穿刺平均时间减少了29.6分钟(-35.2至-24.7分钟),而溶栓治疗平均时间变化不明显(±0分钟[-0.3至+0.3分钟])。二次转移总次数减少了60.9%(-62.8%至-59%);每名患者使用救护车的平均时间没有改变。对于模型参数变量,结果较为稳定。

由此可见,基于卒中严重程度量表的院前分诊策略会对病人的流动和分布产生交大的影响。LVO患者早期取栓术的益处可能大于某些无LVO的患者延迟溶栓治疗相关的危害。进一步进行临床卒中严重程度量表作为分流工具的随机试验是很有必要的,以确认该研究的结果。

原始出处:

Ludwig Schlemm,et al. Impact of Prehospital Triage Scales to Detect Large Vessel Occlusion on Resource Utilization and Time to Treatment.Stroke. 2017. https://doi.org/10.1161/STROKEAHA.117.019431

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    2018-08-25 kkunny
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channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 01 07:34:19 CST 2018, time=2018-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273932, encodeId=e3ea2e3932e6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Dec 30 20:27:05 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273908, encodeId=f28d2e3908ce, 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  5. 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channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 01 07:34:19 CST 2018, time=2018-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273932, encodeId=e3ea2e3932e6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Dec 30 20:27:05 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273908, encodeId=f28d2e3908ce, content=加大投入力度.减少脑血管发病率致残率, beContent=null, objectType=article, channel=null, level=null, likeNumber=14, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sat Dec 30 17:27:28 CST 2017, time=2017-12-30, status=1, ipAttribution=)]
    2018-01-04 虈亣靌

    学习了.涨知识了!

    0

  6. 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channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 01 07:34:19 CST 2018, time=2018-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273932, encodeId=e3ea2e3932e6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Dec 30 20:27:05 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273908, encodeId=f28d2e3908ce, content=加大投入力度.减少脑血管发病率致残率, beContent=null, objectType=article, channel=null, level=null, likeNumber=14, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sat Dec 30 17:27:28 CST 2017, time=2017-12-30, status=1, ipAttribution=)]
    2018-01-02 虈亣靌

    优质资源.共同学习

    0

  7. 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channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 01 07:34:19 CST 2018, time=2018-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273932, encodeId=e3ea2e3932e6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Dec 30 20:27:05 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273908, encodeId=f28d2e3908ce, content=加大投入力度.减少脑血管发病率致残率, beContent=null, objectType=article, channel=null, level=null, likeNumber=14, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sat Dec 30 17:27:28 CST 2017, time=2017-12-30, status=1, ipAttribution=)]
    2018-01-02 happsf

    好好学习

    0

  8. 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channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 01 07:34:19 CST 2018, time=2018-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273932, encodeId=e3ea2e3932e6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Dec 30 20:27:05 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273908, encodeId=f28d2e3908ce, content=加大投入力度.减少脑血管发病率致残率, beContent=null, objectType=article, channel=null, level=null, likeNumber=14, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sat Dec 30 17:27:28 CST 2017, time=2017-12-30, status=1, ipAttribution=)]
    2018-01-01 jyzxjiangqin

    院前检测大血管闲塞.

    0

  9. 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channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 01 07:34:19 CST 2018, time=2018-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273932, encodeId=e3ea2e3932e6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Dec 30 20:27:05 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273908, encodeId=f28d2e3908ce, content=加大投入力度.减少脑血管发病率致残率, beContent=null, objectType=article, channel=null, level=null, likeNumber=14, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sat Dec 30 17:27:28 CST 2017, time=2017-12-30, status=1, ipAttribution=)]
    2017-12-30 131****1460

    学习了受益匪浅

    0

  10. 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channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 01 07:34:19 CST 2018, time=2018-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273932, encodeId=e3ea2e3932e6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Dec 30 20:27:05 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273908, encodeId=f28d2e3908ce, content=加大投入力度.减少脑血管发病率致残率, beContent=null, objectType=article, channel=null, level=null, likeNumber=14, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sat Dec 30 17:27:28 CST 2017, time=2017-12-30, status=1, ipAttribution=)]
    2017-12-30 swfzhanggui

    加大投入力度.减少脑血管发病率致残率

    0

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在选定的卒中患者队列中,在现场的心电图记录可以检测到相关的心律失常。这些结果可以增加住院评估准确性,并且ECG应在急性脑卒中的院前急救中予以考虑。

Heart:院前心电图检查可改善急性冠脉综合征患者转归

英国一项研究表明,院前心电图(PHECG)应用对ST段抬高型心肌梗死(STEMI)和非STEMI患者均具生存获益。论文于4月14日在线发表于《心脏》(Heart)。 此项基于人群的队列研究共纳入288990例急诊就医的患者,并评估了PHECG应用模式,以及其与STEMI和非STEMI患者诊治及临床转归的相关性。 结果显示,与未应用PHECG的患者相比,应用者较为年轻,更可能为男性,并且更可能伴