Neurology:模拟实测下,神经病学研究生处理急性缺血性卒中能否令人满意?

2021-10-30 Naomii MedSci原创

模拟实测下, 神经学研究生在急性缺血性中风的初始治疗中表现令人放心,但在溶栓后出血转化的治疗中经常出错,这表明需要围绕这一低频率、高敏锐度的事件进行更多的教育。

      神经学研究生在急性缺血性中风的初始治疗中表现令人放心,但在溶栓后出血转化的治疗中经常出错,这表明需要围绕这一低频率、高敏锐度的事件进行更多的教育。高保真模拟有望成为急性卒中管理绩效的评估工具。

      在卒中窗口延长时代,符合急性干预条件的患者数量比以往任何时候都多。不幸的是,符合静脉注射组织型纤溶酶原激活剂(TPA)的患者中有四分之一未能得到治疗。此外,tPA给药错误很常见,据报道有高达44%的患者剂量不准确。知道在治疗急性卒中及其并发症(包括出血性中转)时还存在哪些其他临床错误,管理需要及时的诊断、适当的治疗以及与其他专科的协调。

      已建立的卒中护理系统,包括认证卒中中心的多学科急性卒中团队,改善了患者的转归,降低了成本和住院时间。然而,在一个综合性卒中中心团队中分散职责可能会损害受训人员的教育。准备不足的实习生毕业后可能会导致社区医院的不良结果,因为他们没有获得在住院期间护理急性缺血性中风患者和相关并发症所需的复杂技能。因此,在项目完成之前评估神经学研究生的能力是很重要的。近日,有研究人员评估神经学专业的毕业生实习生在急性缺血性卒中、组织型纤溶酶原激活剂(TPA)相关出血和脑疝综合征的治疗中独立于多学科卒中团队的表现。

      在这项基于前瞻性、观察性、单中心模拟的研究中,参与者(从实习医生到主治医生)管理了一名急性缺血性卒中患者,随后tPA相关出血性转化导致脑疝。根据美国心脏协会的相关指南和神经危重护理协会的紧急神经生命支持方案,采用改进的德尔菲方法制定危重行动。主要的结果测量是神经学研究生的关键行动项目总分。通过比较受训者在四个培训水平上的表现来寻找有效性证据来支持我们的发现。

  • 53名实习生(包括31名神经学研究生实习生)和5名主治医师完成了模拟。
  • 神经学研究生完成的关键行动的平均总数为15/22(68%)。
  • 90%的神经学研究生正确使用tPA,84%的人在患者病情恶化后立即停止tPA注射,但只有55%的人根据指南逆转了tPA。
  • 训练水平对关键动作总分有中等程度的影响(1级平均分[标准差(SD)]=7.2(2.8)vs 2级平均分(SD)=12.3(2.6)vs 3级平均分(SD)=13.3(2.2)vs 4级平均分(SD)=16.3(2.4),p<0.001,R2=0.54)。

      神经学研究生在急性缺血性中风的初始治疗中表现令人放心,但在溶栓后出血转化的治疗中经常出错,这表明需要围绕这一低频率、高敏锐度的事件进行更多的教育。高保真模拟有望成为急性卒中管理绩效的评估工具。

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1893439, encodeId=9c911893439da, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Tue Apr 05 11:18:00 CST 2022, time=2022-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1900286, encodeId=0753190028692, content=<a href='/topic/show?id=a0cfe3416be' target=_blank style='color:#2F92EE;'>#研究生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73416, encryptionId=a0cfe3416be, topicName=研究生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Dec 19 01:18:00 CST 2021, time=2021-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001584, encodeId=c8ff2001584f6, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 11 07:18:00 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806471, encodeId=ea2318064e173, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Tue Mar 15 09:18:00 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491423, encodeId=900f149142319, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Mon Nov 01 04:18:00 CST 2021, time=2021-11-01, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1893439, encodeId=9c911893439da, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Tue Apr 05 11:18:00 CST 2022, time=2022-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1900286, encodeId=0753190028692, content=<a href='/topic/show?id=a0cfe3416be' target=_blank style='color:#2F92EE;'>#研究生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73416, encryptionId=a0cfe3416be, topicName=研究生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Dec 19 01:18:00 CST 2021, time=2021-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001584, encodeId=c8ff2001584f6, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 11 07:18:00 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806471, encodeId=ea2318064e173, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Tue Mar 15 09:18:00 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491423, encodeId=900f149142319, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Mon Nov 01 04:18:00 CST 2021, time=2021-11-01, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1893439, encodeId=9c911893439da, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Tue Apr 05 11:18:00 CST 2022, time=2022-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1900286, encodeId=0753190028692, content=<a href='/topic/show?id=a0cfe3416be' target=_blank style='color:#2F92EE;'>#研究生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73416, encryptionId=a0cfe3416be, topicName=研究生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Dec 19 01:18:00 CST 2021, time=2021-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001584, encodeId=c8ff2001584f6, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 11 07:18:00 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806471, encodeId=ea2318064e173, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Tue Mar 15 09:18:00 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491423, encodeId=900f149142319, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Mon Nov 01 04:18:00 CST 2021, time=2021-11-01, status=1, ipAttribution=)]
    2021-11-11 yinhl1978
  4. [GetPortalCommentsPageByObjectIdResponse(id=1893439, encodeId=9c911893439da, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Tue Apr 05 11:18:00 CST 2022, time=2022-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1900286, encodeId=0753190028692, content=<a href='/topic/show?id=a0cfe3416be' target=_blank style='color:#2F92EE;'>#研究生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73416, encryptionId=a0cfe3416be, topicName=研究生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Dec 19 01:18:00 CST 2021, time=2021-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001584, encodeId=c8ff2001584f6, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 11 07:18:00 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806471, encodeId=ea2318064e173, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Tue Mar 15 09:18:00 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491423, encodeId=900f149142319, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Mon Nov 01 04:18:00 CST 2021, time=2021-11-01, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1893439, encodeId=9c911893439da, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Tue Apr 05 11:18:00 CST 2022, time=2022-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1900286, encodeId=0753190028692, content=<a href='/topic/show?id=a0cfe3416be' target=_blank style='color:#2F92EE;'>#研究生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73416, encryptionId=a0cfe3416be, topicName=研究生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Dec 19 01:18:00 CST 2021, time=2021-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001584, encodeId=c8ff2001584f6, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 11 07:18:00 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806471, encodeId=ea2318064e173, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Tue Mar 15 09:18:00 CST 2022, time=2022-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491423, encodeId=900f149142319, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Mon Nov 01 04:18:00 CST 2021, time=2021-11-01, status=1, ipAttribution=)]
    2021-11-01 axin012

相关资讯

JNNP:急性功能性假性卒中与轻度急性缺血性卒中的长期随访比较

每年都有许多患者因怀疑患有急性缺血性中风(AIS)而入住急诊室。有几种情况可以表现为急性中风样症状,其中最常见的是癫痫发作、偏头痛和功能紊乱。后者被称为假性功能性中风(FSM)。虽然AIS患者的预后已

Eur Heart J:残留胆固醇水平升高会增加外周动脉疾病、心肌梗塞和缺血性卒中风险

在一般人群中,残余胆固醇水平升高与PAD风险增加5倍相关,且高于心肌梗塞和缺血性卒中。

JAHA:急性失代偿性心衰患者缺血性卒中

在ADHF住院期间,1.6%的患者发生缺血性卒中。男性、ACS、既往心衰住院和入院时高BNP/NT-proBNP水平与缺血性卒中独立相关。

Stroke:阿司匹林治疗失败的缺血性卒中患者抗血栓治疗可预防卒中

在接受阿司匹林预防性治疗的缺血性卒中患者中,近一半患者出院时使用阿司匹林单药治疗,而没有改变抗血栓药物类别,而另一半出院时使用氯吡格雷单药治疗、双联抗血小板治疗或其他不太常见的药物治疗。

脑出血后何时重启抗血小板治疗?

抗血小板治疗是缺血性卒中和冠状动脉疾病一级和二级预防的基石。

Lancet Neurol:难分伯仲——非免疫原性重组葡激酶与阿尔替普酶治疗急性缺血性卒中患者的比较(FRIDA)

对于急性缺血性卒中患者,非免疫原性葡激酶的疗效不逊于阿尔替普酶。病死率、症状性颅内出血和严重不良事件在各组之间没有显著差异,其在4.5h时间窗内治疗急性缺血性卒中的安全性和有效性有待进一步研究。

拓展阅读

Clin Infect Dis:新倡议能否改善金黄色葡萄球菌菌血症患者的治疗质量

2017年4月,发表在《Clin Infect Dis》的一项由美国科学家进行的回顾性、单中心、准实验研究,考察了一项由药师主导的对抗菌药物管理干预的倡议能否改善金黄色葡萄球菌菌血症(SAB)患者的治疗质量。

J Am Heart Assoc:ST段抬高心梗:我国不同医院治疗质量差异如何?

对于疾病治疗,不同医院间或多或少存在差异,但差异如何则很少有研究。2017年6月,发表在《J Am Heart Assoc》的一项研究调查了我国不同医院对ST段抬高心肌梗死患者的治疗质量的情况。