新型冠状病毒肺炎疫情下定点医院轻型急性缺血性卒中患者门诊精简化诊疗临床疗效分析

摘要/Abstract

摘要：

目的：分析新型冠状病毒（新冠）肺炎疫情防控期间,门诊轻型缺血性卒中患者临床特征及门诊精简化诊疗的有效性。方法：连续收集2020年1月27日至9月27日期间在北京市门头沟区医院神经内科门诊就诊的轻型急性缺血性卒中患者作为观察组（87例）,进行精简化门诊诊疗,随访7 d 美国国立卫生院卒中量表（National Institutes of Health Stroke Scale,NIHSS）和90 d 改良Rankin量表（modified Rankin scale,mRS）评分。2019年同期住院治疗的轻型急性缺血性卒中患者作为对照组（75例）。比较2组患者临床资料的差异。结果：单因素分析显示观察组发病到就诊时间[3（2,4） d] 明显长于对照组[1（0.3,3） d]（Z=-4.234,P=0.000）。观察组输液时长[6（5,7） d比10（7,12） d,P=0.000]和治疗费用[（5 666.05±2 343.78）元比（12 590.11±3 815.52）元,P=0.000]明显低于对照组。2组就诊时NIHSS评分、7 d NIHSS评分、90 d mRS良好率（90 d mRS≤2分）无明显差异。结论：疫情下轻型卒中门诊精简化诊疗7 d NIHSS评分及90 d mRS良好率与住院患者相比无明显差异。而门诊患者治疗费用显著低于住院患者。在新冠肺炎疫情流行期间或轻型卒中患者不适宜住院的其他情况时,可采用门诊精简化诊疗方案进行管理。

关键词:新型冠状病毒肺炎,疫情,轻型卒中,门诊患者,精简化诊疗

Abstract:

ObjectiveTo summarize the clinical characteristics of outpatients with acute mild stroke and analyze the therapeutic efficacy of simplified diagnosis and treatment for the patients during the period of epidemic prevention and control.MethodsEighty-seven outpatients with acute mild stroke in Beijing Men Tou Gou District Hospital from January 27 to September 27 in 2020 were enrolled as observation group (n=87). Simplified diagnosis and treatment were performed on the observation group, and the stroke-related neurologic deficits were evaluated with 7-day National Institutes of Health Stroke Scale (NIHSS) score and 90-day modified Rankin scale (mRS) score. Seventy-five patients with acute mild ischemic stroke admitted to were enrolled as control group (n=75) during the same period. The clinical characteristics, biochemistry index, 7-day NIHSS score and 90-day mRS score were analyzed and compared between control group and observation group.ResultsUnivariate analysis showed the time from appearing stroke symptom to receiving treatment in the observation group [3（2,4） day] was significantly longer than that in the control group[ 1（0.3,3） day]（Z=-4.234,P=0.000), while the infusion time of therapeutic medicine and treatment cost in observation group were significantly lower than that in control group[6（5,7） dvs10（7,12） d,P=0.000; (5 666.05±2 343.78) yuanvs(12 590.11±3 815.52) yuan,P=0.000 ]. The two groups had no significant differences in 0-day NIHSS score, 7-day NIHSS score and 90-day mRS score （90 d mRS≤2）[2(1,3)vs2(1,3);1(0,1)vs1(0,3); 87.35%vs84.00%,P>0.05].ConclusionsThe patients with acute mild stroke were not necessary to be hospitalized and could be managed with simplified diagnosis and treatment in outpatient department during the period of pandemic or non-pandemic.

Key words:COVID-19,Epidemic,Mild stroke,Outpatient,Simplified diagnosis and treatment

中图分类号:

R733.71

高彩红. 新型冠状病毒肺炎疫情下定点医院轻型急性缺血性卒中患者门诊精简化诊疗临床疗效分析[J]. 内科理论与实践, 2022, 17(05): 385-389.

GAO Caihong. Analysis of therapeutic efficacy of simplified diagnosis and treatment for outpatients with acute mild ischemic stroke in designated hospitals during the COVID-19 pandemic[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(05): 385-389.

图/表3

表1

观察组和对照组临床基线资料的比较[n(%)/$\bar{x}±s$]

项目	对照组（75例）	观察组（87例）	t/χ²	P
年龄（岁）	63.71±11.38	63.02±13.01	-0.353	0.724
男性[n（%）]	57(76.0)	62(71.3)	0.463	0.496
吸烟[n（%）]	38(50.7)	50(57.5)	0.752	0.386
高血压[n（%）]	60(80.0)	71(81.6)	0.067	0.795
糖尿病[n（%）]	32(42.7)	30(34.5)	1.142	0.285
房颤[n（%）]	4(5.3)	2(2.3)	1.040	0.308
中重度颅内外动脉狭窄[n（%）]	38(50.6)	33(37.9)	2.654	0.103
LDL-C (mmol/L)	3.66±2.84	3.34±0.94	-0.977	0.330
Hcy (μmol/L)	16.43±7.66	15.21±7.11	-1.049	0.296
梗死类型[n（%）] 单纯后循环[n（%）]	31(41.3)	28(32.2)	1.456	0.228
LAA	45（60.0）	54(62.1)	0.073	0.788
SAO	23(30.7)	29(33.3)	0.131	0.717
CE	2(2.7)	1(1.2)	0.510	0.475
OE+UE	5(6.7)	3（3.5）	0.889	0.346

表1

项目	对照组（75例）	观察组（87例）	t/Z	P
就诊时NIHSS评分（分）	2（1,3）	2（1,3）	-1.022	0.307
发病时间（d）	1（0.3,3）	3（2,4）	-4.234	0.000
输液时长（d）	10（7,12）	6（5,7）	-8.167	0.000
治疗费用（元）	12 590.11±3 815.52	5 666.05±2 343.78	-14.12	0.000

表2

项目	对照组（75例）	观察组（87例）	Z/χ²	P
7 dNIHSS评分（分）	1（0,3）	1（0,1）	-1.755	0.079
90 dmRS≤2分	63（84.00）	76（87.35）	0.372	0.542

表3

参考文献18

[1]	Nicola M, Alsafi Z, Sohrabi C, et al. The socio-economic implications of the coronavirus pandemic (COVID-19)[J]. Int J Surg, 2020 78: 185-193. doi:S1743-9191(20)30316-2pmid:32305533
[2]	王伊龙, 赵性泉, 刘新峰, 等. 高危非致残性缺血性脑血管事件诊疗指南[J]. 中国卒中杂志, 2016, 11(6): 481-491.
[3]	Hurst K, Lee R, Sideso E, et al. Delays in the presentation to stroke services of patients with transient ischaemic attack and minor stroke[J]. Br J Surg, 2016, 103(11): 1462-1466. doi:10.1002/bjs.10199pmid:27529453
[4]	Khatri P, Conaway MR, Johnston KC, et al. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke[J]. Stroke, 2012, 43(2): 560-562. doi:10.1161/STROKEAHA.110.593897pmid:22052513
[5]	Coull AJ, Lovett JK, Rothwell PM. Population based study of early risk of stroke after transient ischaemic attack or minor stroke[J]. BMJ, 2004, 328(7435): 326. doi:10.1136/bmj.37991.635266.44 URL
[6]	中华医学会神经病学分会中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
[7]	Schwartz JK, Capo-Lugo CE, Akinwuntan AE, et al. Classification of mild stroke[J]. PM R, 2019, 11(9): 996-1003. doi:10.1002/pmrj.12142 URL
[8]	Laurencin C, Philippeau F, Blanc-Lasserre K, et al. Thrombolysis for acute minor stroke: outcome and barriers to management[J]. Cerebrovasc Dis, 2015, 40(1-2): 3-9. doi:10.1159/000381866pmid:25998791
[9]	Khatri P, Conaway MR, Johnston KC, et al. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke[J]. Stroke, 2012, 43(2): 560-562. doi:10.1161/STROKEAHA.110.593897pmid:22052513
[10]	Zhao Y, Song Y, Guo Y, et al. Endovascular thrombectomyvs. medical treatment for mild stroke patients[J]. J Stroke Cerebrovasc Dis, 2020, 29(12): 105258. doi:10.1016/j.jstrokecerebrovasdis.2020.105258 URL
[11]	Edwards DF, Hahn M, Baum C, et al. The impact of mild stroke on meaningful activity and life satisfaction[J]. J Stroke Cerebrovasc Dis, 2006, 15(4): 151-157. pmid:17904068
[12]	Strambo D, Zambon AA, Roveri L, et al. Defining minor symptoms in acute ischemic stroke[J]. Cerebrovasc Dis, 2015, 39(3-4): 209-215. doi:10.1159/000375151pmid:25791530
[13]	Koge J. Reperfusion therapy in patients with minor or mild ischemic stroke[J]. Rinsho Shinkeigaku, 2019, 59(2): 84-92. doi:10.5692/clinicalneurol.cn-001255 URL
[14]	Markus HS, Brainin M. COVID-19 and stroke-A global World Stroke Organization perspective[J]. Int J Stroke, 2020, 15(4): 361-364. doi:10.1177/1747493020923472pmid:32310017
[15]	Akhtar N, Kamran S, Elkhider H, et al. Progression of stroke deficits in patients presenting with mild symptoms[J]. PloS One, 2020, 15(4): e0231448. doi:10.1371/journal.pone.0231448 URL
[16]	Ghanchi H, Takayanagi A, Savla P, et al. Effects of the COVID-19 pandemic on stroke patients[J]. Cureus, 2020, 12(8): e9995.
[17]	周丽琼, 王瑞香, 褚晓凡, 等. 新型冠状病毒肺炎疫情对急性缺血性卒中患者就诊时间的影响[J]. 中风与神经疾病杂志, 2020, 37(5): 406-408.
[18]	Luo W, Li J, Li Z, et al. Effects of the COVID-19 pandemic on reperfusion therapy for acute ischemic stroke patients in Huizhou City, China[J]. Neurol Sci, 2021, 42(2): 467-473. doi:10.1007/s10072-020-04938-wpmid:33409830