[1]苟亚军,胡俊,李迎春,等.远程医疗会诊在区域化网络协同诊治急性缺血性脑卒中的应用研究[J].第三军医大学学报,2020,42(19):1965-1972.
 GOU Yajun,HU Jun,LI Yingchun,et al.Application of telemedicine consultation system in coordination of regionalization network for diagnosis and treatment of acute ischemic stroke [J].J Third Mil Med Univ,2020,42(19):1965-1972.
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远程医疗会诊在区域化网络协同诊治急性缺血性脑卒中的应用研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
42卷
期数:
2020年第19期
页码:
1965-1972
栏目:
临床医学
出版日期:
2020-10-15

文章信息/Info

Title:
Application of telemedicine consultation system in coordination of regionalization network for diagnosis and treatment of acute ischemic stroke 
作者:
苟亚军胡俊李迎春喻恒陈康宁
重庆市沙坪坝区人民医院:神经外科,急诊科;陆军军医大学(第三军医大学)第一附属医院神经内科;重庆市沙坪坝区陈家桥医院急诊科(重庆医药高等专科学校附属医院)
Author(s):
GOU Yajun HU Jun LI Yingchun YU Heng CHEN Kangning

Department of Neurosurgery, 4Department of Emergency, Shapingba District People’s Hospital, Chongqing, 400030; 2Department of Neurology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038; 3Department of Emergency, Chenjiaqiao Hospital Affiliated to Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China

关键词:
急性缺血性脑卒中远程医疗会诊区域化网络协同诊治
Keywords:
acute ischemic stroke telemedicine consultation regionalization network collaborative diagnosis and treatment
分类号:
R319; R459.7; R743.3
文献标志码:
A
摘要:

目的探讨远程医疗会诊在区域化网络协同诊治急性缺血性脑卒中患者的临床应用及效果。方法收集2017年1月至2019年12月就诊的急性缺血性脑卒中患者,其中2017年1月至2018年12月我院区域化网络协同治疗的28例急性缺血性脑卒中患者设为对照组,2019年1-12月我院采用远程医疗会诊联合区域化网络协同治疗的32例急性缺血性脑卒中患者设为观察组,比较两组间发病首次医疗接触时间(first medical contact time,FMCT)、入院到行CTA检测时间(door to imaging time,DIT)、起病至溶栓时间(onset to needle time,ONT)、起病至入院时间(onset to door time,ODT)、入院至静脉溶栓药物开始治疗时间(door to needle time,DNT)、DNT≤60 min达标率、溶栓率、住院时间、并发症及临床结局。结果两组患者在诊疗时效性方面,与对照组DIT[(61.71±21.38)min]、ONT[(201.43±56.44 )min]、DNT[(101.02±41.40) min]时间比较,观察组患者DIT[(32.10±7.44)min]、ONT[(166.34±42.37)min]、DNT[(64.97±14.43)min]时间明显缩短(P<0.05);观察组DNT≤60 min达标率、溶栓率、住院时间、并发症及临床结局[59.3%、68.8%、(16.94±8.58)d、6.3%、3.1%]均优于对照组[32.1%、42.0%、(22.14±4.87)d、28.6%、21.4%](P<0.05)。结论通过将远程医疗会诊融入区域化网络协同诊治,可以缩短急性缺血性脑卒中患者的DIT、ONT、DNT时间,提高溶栓比率,改善患者的预后,提高医疗质量。

Abstract:

ObjectiveTo explore the clinical application and effect of the telemedicine consultation system in the diagnosis and treatment of the coordination of the regionalization network for patients with acute ischemic stroke. MethodsA total of 60 patients with acute ischemic stroke admitted to our 2 hospitals from January 2017 to December 2019 were enrolled in this study. Those admitted from January 2017 to December 2018 were assigned into control group because of their diagnosis and treatment under the coordination of the regionalization network, and those admitted between January and December 2019 were into observation group due to the performance of the telemedicine consultation system. The first medical contact time (FMCT), admission to CTA time (door to imaging time, DIT), and onset to needle time (ONT), onset to door time (ODT), door to needle time (DNT), qualified rate (DNT≤60 min), intravenous thrombolysis rate, length of hospital stay, incidences of complications, and treatment, outcomes were observed and compared between the 2 groups. ResultsIn the timeliness of diagnosis and treatment, the observation group had significantly shorter DIT (32.10±7.44 vs 61.71±21.38 min), ONT (166.34±42.37 vs 201.43±56.44 min) and DNT (64.97±14.43 vs 101.02±41.40 min) when compared with the control group (P<0.05). What’s more, the qualified rate (59.3% vs 32.1%), thrombolytic ratio (68.8% vs 42.0%), hospitalization time (16.94±8.58 vs 22.14±4.87 d), complication incidence (6.3% vs 28.6%) and ratio of clinical outcome (3.1% vs 21.4%) were all better in the observation group than the other group (P<0.05). ConclusionWhen the telemedicine consultation system is applied in the diagnosis and treatment of the coordination of the regionalization network, the DIT, DNT and ONT times can be shortened, the thrombolytic ratio can be increased, the prognosis of patients can be improved, and the quality of medical care can be promoted for the patients with acute ischemic stroke.

参考文献/References:

[1]仇建婷,严江志,郭婷婷,等.老年急性轻型缺血性脑卒中患者的脑梗死模式与病因分析[J].中华老年心脑血管病杂志,2019,21(11):1125-1128. DOI:10.3969/j.issn.1009-0126.2019.11.002. 
QIU J T,YANJZ,GUO T T, et al. Patterns and etiology of cerebral infarction in elderly acute mild ischemic stroke patients[J].Chin J Geriatr Heart Brain Vessel Dis,2019,21(11):1125-1128.DOI:10.3969/ j.issn.1009-0126.2019.11.002.
[2]BULWA Z, GOMEZ C R, MORALES-VIDAL S, et al. Correction to: management of blood pressure after acute ischemic stroke[J]. Curr Neurol Neurosci Rep, 2019, 19(6): 1. DOI:10.1007/s11910-019-0963-6.
[3]韩晓森,董艳玲,田英平.急性缺血性脑卒中院前救治的现状及研究进展[J].中国急救医学,2019,39(12):1202-1205. DOI:10.3969/j.issn.1002-1949.2019.12.014.
HAN X S, DONG Y L, TIAN Y P. Current situation and research development of prehospital treatment with acute ischemic stroke[J]. Chin J Crit Care Dec,2019,39(12):1202-1205. DOI:10.3969/j.issn.1002-1949.2019.12.014.
[4]JAUCH E C,SAVER J L,ADAMS H P,et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J].Stroke, 2013,44(3):870-947. DOI:10.1161/STR.0b013e3182 84056a.
[5]刘枫荻,赵蓉,王硕,等.急诊启动急性缺血性脑卒中静脉内溶栓治疗对开始溶栓平均时间的影响及其安全性探讨[J].中国临床神经科学,2017,25(1):49-53. DOI:10.3969/j.issn.1008-0678.2017.01.008.
LIU F D, ZHAO R, WANG SH, et al. Start Intravenous Thrombolysis in Emergency Room: Door-to-needle Time and Safety of Acute Ischemic Stroke[J].ChinJClinNeurosci,2017,25(1):49-53. DOI:10.3969/j.issn.1008-0678.2017.01.008.
[6]王耀辉,张重阳,孙伟,等.基于急救医疗服务的院前干预对急性缺血性脑卒中静脉溶栓门-针时间的影响[J].中华危重病急救医学, 2018, 30(7): 667-670. DOI:10.3760/cma.j.issn.2095-4352.2018.07.010.
WANG Y, ZHANG C, SUN W, et al. Effect of prehospital intervention based on emergency medical services on door-to-needle time of thrombolysis in acute ischemic stroke[J]. Chin Crit Care Med, 2018, 30(7): 667-670. DOI:10.3760/cma.j.issn.2095-4352.2018.07.010. 
[7]彭斌,刘鸣,崔丽英. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018, 51(9): 666-682. DOI:10.3760/cma.j.issn.1006-7876.2018.09.004.
PENG B,LIU M,CUI L Y.Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol, 2018,51(9):666-682. DOI:10.3760/cma.j.issn.1006-7876.2018.09.004.
[8]王晓田,李振华.区域化网络协同救治优化急性ST段抬高心肌梗死早期再灌注治疗[J].中国介入心脏病学杂志,2013,21(5):290-296. DOI:10.3969/j.issn.1004-8812.2013.05.005.
WANG X T, LI Z H. Regionalization network synergy where optimization STEMI early reperfusion therapy[J].Chin J Intervent Cardiol,2013,21(5):290-296. DOI:10.3969/j.issn.1004-8812.2013.05.005.
[9]严金川,梁仪,袁伟,等.急性心脑血管病区域化协同救治的网络构建[J].中华老年心脑血管病杂志,2019,21(01):90-92. DOI:10.3969/j.issn.1009-0126.2019.01.023.
YAN J C, LIANG Y, YUAN W, et al. Network construction of regional collaborative treatment for acute cardiovascular and cerebrovascular diseases[J].Chin J Geriatr Heart Brain Vessel Dis,2019,21(1):90-92. DOI:10.3969/j.issn.1009-0126.2019.01.023.
[10]韩宁,沈雷,黎佳思,等.急性缺血性脑卒中救治流程对院内缺血性脑卒中的救治作用[J].第二军医大学学报,2018,39(3):269-272. DOI:10.16781/j.0258-879x.2018.03.0269.
HAN N, SHEN L, LI J S, et al. Effect of rescue process of acute ischemic stroke on treating in-hospital ischemic stroke[J].Acad J Second Mil Med Univ,2018,39(3):269-272. DOI:10.16781/j.0258-879x.2018.03.0269.
[11]苏建华,韩姝,张俊华,等.脑卒中一体化管理对缩短急性缺血性脑卒中患者救治时间的影响[J].江苏卫生事业管理,2019,30(3):319-321. DOI:10.3969/j.issn.1005-7803.2019.03.015.
SU J H, HAN S, ZHANG J H, et al. The Influence of Integrated Stroke Management and In-hospital Stroke Optimization in Reducing the Treatment Time of Patients with Acute Ischemic Stroke[J]. Jiangsu Heal Syst Mgt,2019,30(3):319-321. DOI:10.3969/j.issn.1005-7803.2019.03.015.
[12]石建成,魏淑惠,吴俊峰,等. 远程三级诊疗模式在基层医学影像科的临床应用[J]. 中国数字医学,2019,14(9):65-67. DOI:10.3969/j.issn.1673-7571.2019.09.023.
SHI J C, WEI S H, WU J F, et al. Clinical Application of the Three-level Remote Diagnosis and Treatment Model in the Basic-level Medical Imaging Department[J]. Chin Digit Med,2019,14(9):65-67. DOI:10.3969/j.issn.1673-7571.2019.09.023.
[13]FONAROW G C, REEVES M J, SMITH E E, et al. Characteristics, performance measures, and in-hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelines-stroke[J]. Circ Cardiovasc Qual Outcomes, 2010, 3(3): 291-302. DOI:10.1161/circoutcomes.109.921858.
[14]张美霞,陈智才,张睿婷,等.院前预通知流程改善急性缺血性卒中患者血管内治疗的预后[J].中国卒中杂志,2018,13(2):114-121. DOI:10.3969/j.issn.1673-5765.2018.02.004.
ZHANG M X, CHEN Z C, ZHANG R T, et al. Prehospital Notification Procedure Improves Endovascular Treatment Outcome in Patients with Acute Ischemic Stroke[J].Chin J Stroke,2018,13(2):114-121. DOI:10.3969/j.issn.1673-5765.2018.02.004.
[15]陈小燕.优化院内卒中应急流程在急性缺血性卒中溶栓中的应用探讨[J].江西医药,2017,52(8):769-771. DOI:10.3969/j.issn.1006-2238.2017.08.018.
CHEN X Y. Optimization of hospital stroke emergency process in thrombolysis of acute ischemic stroke[J]. Jiangxi Med J,2017,52(8):769-771. DOI:10.3969/j.issn.1006-2238.2017.08.018.
[16]ASTRUP J, SIESJ B K, SYMON L. Thresholds in cerebral ischemia-the ischemic penumbra[J]. Stroke, 1981, 12(6): 723-725. DOI:10.1161/01.str.12.6.723.
[17]JAUCH E C, SAVER J L, ADAMS H P Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke,2013,44(3):870-947. DOI:10.1161/STR.0b013e318284056a.
[18]COSTALAT V, MACHI P, LOBOTESIS K, et al. Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: a prospective 50-patient single-center study: timing, safety, and efficacy[J]. Stroke, 2011, 42(7): 1929-1935. DOI:10.1161/strokeaha.110.608976.
[19]程景丽,史树海,薛镭.诊疗流程的优化在改善缺血性脑卒中医疗质量中的作用[J].中国卫生产业,2019,16(12):16-19,22. DOI:10.16659/j.cnki.1672-5654.2019.12.016.
CHENG J L, SHI S H, XUE L. The Role of Optimization of the Diagnosis and Treatment Process in Im-proving the Quality of Medical Treatment of Ischemic Stroke[J]. Chin Heal Indust,2019,16(12):16-19,22. DOI:10.16659/j.cnki.1672-5654.2019.12.016.
[20]李光建,史树贵,周振华,等.院内卒中救治绿色通道建立、优化及区域救治网络的建立[J].中国卒中杂志,2018,13(2):127-131.DOI:CNKI:SUN:ZUZH.0.2018-02-006.
LI G J, SHI S G, ZHOU Z H, et al. Construction and Optimization of In-hospital Stroke Fast Channel and Construction of Regional Stroke Rescue Network[J]. Chin J Stroke,2018,13(2):127-131. DOI:10.3969/j.issn.1673-5765.2018.02.006.

更新日期/Last Update: 2020-10-02