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The Influence Of The Construction Of Kunming Stroke Prevention And Treatment Center On Stroke Green Channel On The Effectiveness Of Construction

Posted on:2024-07-28Degree:MasterType:Thesis
Country:ChinaCandidate:J ZhangFull Text:PDF
GTID:2544307178953709Subject:Neurology
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Objectives: The construction of stroke centers has effectively improved the standardized treatment of stroke in medical institutions at all levels.The National Cerebral Prevention Commission analyzes the construction of stroke centers in China every year,but there are relatively few analyses on the construction of prevention and treatment centers based on regions.This study analyzed the three-year data of 17 stroke prevention and treatment centers in Kunming City,including baseline data,pre-hospital emergency treatment indicators,green channel construction indicators,treatment measures and safety indicators,and intra-regional referral rate,and analyzed the effectiveness and shortcomings of the construction of stroke prevention and treatment centers in Kunming City on the construction of green channel for stroke.To provide the basis for improving stroke quality control and stroke prevention and control policy in Kunming City.Methods: 1.In this study,a total of 17 stroke prevention and treatment centers qualified by Yunnan Medical Evaluation Center from January 1,2019 to December31,2021 were included,and 1361 patients with acute ischemic stroke were treated and treated with intravenous thrombolysis.2.Baseline data of ischemic stroke patients admitted to the hospital were collected(the number of cerebral infarction patients admitted,the number of intravenous thrombolysis patients,and the rate of intravenous thrombolysis),pre-hospital emergency indicators(ODT time,hospital arrival method,and thrombolytic location),green channel construction indicators(ONT time,DNT time),therapeutic measures and therapeutic safety indicators(the use of thrombolytic drugs and the standard use of antiplatelet aggregation Drug therapy,standard use of lipid-lowering drug therapy,incidence of complications),intra-regional referral rate index,etc.The construction data of Kunming Stroke prevention and Treatment Center in different years and different regions were compared,and the influence of the construction of the stroke prevention and treatment center on the green channel of stroke in Kunming was analyzed in multiple dimensions.Results: 1.Results of Kunming Stroke Prevention and Treatment Center from January 2019 to December 2021.(1)17,851 patients with cerebral infarction were treated: 6001 in 2019,5489 in 2020 and 6361 in 2021;Among them,1361 patients had intravenous thrombolysis: 228 in 2019,508 in 2020 and 625 in 2021;Intravenous thrombolysis rate: 3.81% in 2019,9.23% in 2020,9.82% in 2021.The number of patients with cerebral infarction admitted,the number of thrombolysis and the rate of intravenous thrombolysis were significantly increased,and the difference was statistically significant(P<0.001).(2)The time from onset to hospital was 96.5min in2019,100 min in 2020 and 97 min in 2021,and the difference was not statistically significant(P>0.05).(3)The way of coming to hospital: the proportion of ambulance coming to hospital was 18.4% in 2019,16.9% in 2020 and 22.2% in 2021,while the proportion of self-coming to hospital was 81.6% in 2019,83.1% in 2020 and 77.8% in2021,and the difference was not statistically significant(P>0.05).(4)Location of thrombolysis: the proportion of thrombolysis in non-stroke wards was 9.2% in 2019,26.8% in 2020 and 42.7% in 2021,while the proportion of thrombolysis in stroke wards was 90.8% in 2019,73.2% in 2020 and 57.3% in 2021,and the difference in location was statistically significant(P<0.001),pairwise comparison showed that the proportion of patients undergoing intravenous thrombolysis in non-inpatient wards in2020 was significantly higher than that in 2019,and that in 2021 was significantly higher than that in 2019 and 2020,the difference was statistically significant(P<0.001).(5)The ONT time was 169 min in 2019,161 min in 2020 and 147 min in2021.The ONT time of patients with cerebral infarction intravenous thrombolysis was shorter in 2021 than in 2020(P<0.05).(6)DNT median time:56min in 2019,53 min in 2020 and 43 min in 2021.DNT time of patients with cerebral infarction intravenous thrombolysis in 2021 is significantly shorter than that in 2020 and 2019(P<0.05).(7)Therapeutic measures: The proportion of intravenous thrombolytic therapy with alteplase was 78.9% in 2019,81.9% in 2020 and 87.4% in 2021,which was significantly higher in 2021 than in 2019 and 2020(P<0.05).The proportion of patients treated with standard antiplatelet aggregation drugs was 75% in 2019,75.4%in 2020 and 72.5% in 2021,and the difference was not statistically significant(P>0.05).The proportion of patients treated with standard lipid-lowering drugs was90.8% in 2019,87.6% in 2020 and 84% in 2021,and the composition of patients treated with standard lipid-lowering drugs in 2021 was significantly increased compared with that in 2019(P<0.05),the difference was not statistically significant compared with 2020(P>0.05).(9)Complications of intravenous thrombolysis: the incidence of no complications will be 84.6% in 2019,84.1% in 2020 and 77.3% in2021.The composition of no complications patients in 2021 will be lower than that in2020,while the composition of gingival bleeding patients in 2021 will be higher than that in 2019 and 2020,and the difference is statistically significant(P<0.05).(9)Referral rate: 11.4% in 2019,12.2% in 2020,14.2% in 2021,and 3.1% in 2019,1.2%in 2020,and 1.6% in 2021 in primary medical institutions,showing no statistically significant differences(P>0.05).2.This study analyzed the intravenous thrombolysis data of cerebral infarction from January 2019 to December 2021 in the Central urban Center of Kunming City.(1)10,985 patients with cerebral infarction were treated: 3693 in 2019,3301 in 2020,and 3991 in 2021;There were 472 patients with intravenous thrombolysis: 30 in 2019,177 in 2020,and 265 in 2021;Intravenous thrombolysis rate: 0.81% in 2019,5.36%in 2020,6.63% in 2021.The number of patients with cerebral infarction admitted,the number of thrombolysis and the rate of intravenous thrombolysis were significantly increased,and the difference was statistically significant(P<0.001).(2)The time from onset to hospital was 97 min in 2019,110 min in 2020,104 min in 2021,and the difference was not statistically significant(P>0.05).(3)The way of coming to hospital:the proportion of ambulance coming to hospital was 20% in 2019,27.7% in 2020 and30.2% in 2021,while the proportion of self-coming to hospital was 80% in 2019,72.3% in 2020 and 69.8% in 2021,and the difference was not statistically significant(P> 0.05).(4)Location of thrombolysis: the proportion of thrombolysis in non-stroke wards was 10% in 2019,55.9% in 2020 and 66% in 2021,while the proportion of thrombolysis in stroke wards was 90% in 2019,44.1% in 2020 and 34% in 2021.The difference in location of thrombolysis was statistically significant(P<0.001),pairwise comparison showed that the composition of patients receiving intravenous thrombolysis in non-thrombolytic wards in 2020 and 2021 increased significantly compared with that in 2019,and the difference was statistically significant(P<0.001).(5)The ONT time was 199.5min in 2019,175 min in 2020 and 150 min in2021.The ONT time of patients with cerebral infarction in 2021 was shorter than that in 2020,and the difference was statistically significant(P<0.05).(6)DNT median time: 84 min in 2019,57 min in 2020 and 38 min in 2021.DNT time of patients with cerebral infarction intravenous thrombolysis in 2021 is significantly shorter than that in 2020 and 2019,and the difference is statistically significant(P<0.05).(7)Therapeutic measures: The proportion of intravenous thrombolytic therapy with alteplase was 90% in 2019,73.4% in 2020 and 81.1% in 2021,and the difference was not statistically significant(P<0.05).The proportion of patients treated with standard antiplatelet aggregation drugs was 86.7% in 2019,75.1% in 2020 and 77.4% in 2021,and the difference was not statistically significant(P>0.05).The proportion of patients treated with standard lipid-lowering drugs was 96.7% in 2019,87% in 2020 and 85.7% in 2021,and the difference was not statistically significant(P>0.05).(8)Complications of intravenous thrombolysis: the incidence of no complications was93.3% in 2019,81.9% in 2020 and 80.4% in 2021,and the difference was not statistically significant(P>0.05).(9)Referral rate: 13.3% referred to advanced stroke centers in 2019,6.8% in 2020,11.3% in 2021,and 0% referred to primary medical institutions in 2019,0% in 2020,and 0% in 2021,with no statistically significant differences(P>0.05).3.This study analyzed the intravenous thrombolysis data of cerebral infarction in Kunming Suburban Stroke Center from January 2019 to December 2021.(1)6866patients with cerebral infarction were treated: 2308 in 2019,2188 in 2020 and 2370 in2021;Among them,there were 889 patients with intravenous thrombolysis: 198 in2019,331 in 2020 and 360 in 2021;Intravenous thrombolysis rate: 8.57% in 2019,15.12% in 2020 and 15.18% in 2021.The number of patients with cerebral infarction admitted,the number of thrombolysis and the rate of intravenous thrombolysis were significantly increased,and the difference was statistically significant(P<0.001).(2)The time from onset to hospital was 96.5min in 2019,95 min in 2020 and 91 min in2021,and the difference was not statistically significant(P>0.05).(3)The way of coming to hospital: the proportion of ambulance coming to hospital was 18.2% in2019,11.2% in 2020 and 16.4% in 2021,while the proportion of self-coming to hospital was 81.8% in 2019,88.8% in 2020 and 83.6% in 2021,and the difference was not statistically significant(P>0.05).(4)Location of thrombolysis: the proportion of thrombolysis in non-stroke wards was 9.1% in 2019,11.2% in 2020 and 25.6% in2021,and that in stroke wards was 90.9% in 2019,88.8% in 2020 and 74.4% in 2021.The difference in location of thrombolysis was statistically significant(P<0.001),the number of patients with cerebral infarction receiving intravenous thrombolysis in non-stroke wards in 2021 was significantly higher than that in 2019 and 2020,and the difference was statistically significant(P<0.001).(5)ONT time: 198 min in 2019,331 min in 2020,360 min in 2021,and the difference was not statistically significant(P>0.05).(6)DNT median time: 53.5min in 2019,51 min in 2020 and 47 min in 2021.DNT time of patients with cerebral infarction intravenous thrombolysis in 2021 is significantly shorter than that in 2019,and the difference is statistically significant(P<0.05).(7)Therapeutic measures: : The proportion of patients receiving intravenous thrombolytic therapy with alteplase was 77.3% in 2019,86.4% in 2020 and 91.9% in2021,and the proportion of patients receiving intravenous thrombolytic therapy with alteplase in 2020 and 2021 was significantly higher than that in 2019.The difference was statistically significant(P < 0.05).The proportion of patients treated with standard antiplatelet aggregation drugs was 73.2% in 2019,75.5% in 2020 and 68.9%in 2021,and the difference was not statistically significant(P>0.05).The proportion of patients treated with standard lipid-lowering drugs was 89.9% in 2019,87.9% in2020 and 82.8% in 2021,with statistical significance(P < 0.05).(8)Complications of intravenous thrombolysis: the incidence of no complications was 83.3% in 2019,85.2% in 2020 and 75% in 2021,the difference being statistically significant(P<0.05).(9)Referral rate: 11.1% in 2019,15.1% in 2020,and 16.4% in 2021 to advanced stroke centers;3.5% in 2019,1.2% in 2020,and 2.8% in 2021 to primary medical institutions;the differences were not statistically significant(P>0.05).Conclusions: Through the construction of stroke prevention and treatment centers,Kunming City has built 17 prevention and treatment centers,the number of AIS intravenous thrombolysis increased,the rate of intravenous thrombolysis increased,the regional stroke treatment network has been established,and Kunming City’s stroke treatment ability has been significantly improved.By improving the ability of pre-hospital first aid,rationally planning hospital diagnosis and treatment routes,and shortening hospital process time,the regionalization of Kunming Stroke center has been effective.The ability of pre-hospital first aid,hospital green channel construction and standard treatment for ischemic stroke in Kunming City has been significantly improved.Further need to strengthen public education,health education work;Strengthening the construction of grassroots treatment stations and the promotion of mobile stroke units;Continue to promote regional linkage between advanced stroke centers and stroke prevention centers.
Keywords/Search Tags:stroke center, rescue capacity, pre-hospital emergency, green channel, regional construction
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