湖南地區(qū)三類不同級(jí)別醫(yī)院蛛網(wǎng)膜下腔出血診療現(xiàn)狀調(diào)查
發(fā)布時(shí)間：2019-07-03 14:22
【摘要】：目的：本研究通過回顧性分析考察湖南地區(qū)三類不同級(jí)別醫(yī)院(一級(jí)、二級(jí)、三級(jí))蛛網(wǎng)膜下腔出血(SAH)患者在診斷技術(shù)的應(yīng)用、治療路徑的選擇和近期預(yù)后等的差異,為我國制訂蛛網(wǎng)膜下腔出血實(shí)用的、規(guī)范化的診療技術(shù)與流程,以及為政府衛(wèi)生資源的投入決策提供參考。 方法：采用回顧性分析對(duì)2009年1月--2012年7月期間,來自湖南省、區(qū)(縣)、鄉(xiāng)(鎮(zhèn))三類不同級(jí)別醫(yī)院(一級(jí)、二級(jí)與三級(jí)醫(yī)院共5家醫(yī)院)總共399例蛛網(wǎng)膜下腔出血(SAH)患者的病史資料、實(shí)驗(yàn)室資料、病因?qū)W、癥狀學(xué)、診斷技術(shù)的應(yīng)用、治療路徑的選擇、以及近期預(yù)后進(jìn)行調(diào)查分析,并進(jìn)行統(tǒng)計(jì)學(xué)處理。 結(jié)果：1、人口學(xué)資料：三類不同級(jí)別(一級(jí)、二級(jí)、三級(jí))醫(yī)院蛛網(wǎng)膜下腔出血(SAH)患者在性別、年齡、身高、體重、體重指數(shù)等人口學(xué)資料比較無統(tǒng)計(jì)學(xué)意義(P0.05)。2、既往疾病史資料：在腦卒中史、冠心病史、糖尿病史、高血壓病史、腦血管病家族史、服用抗血小板藥物等比較,無統(tǒng)計(jì)學(xué)差異意義(P0.05)。但三類不同級(jí)別醫(yī)院蛛網(wǎng)膜下腔出血(SAH)患者的吸煙史和飲酒史相互比較有統(tǒng)計(jì)學(xué)差異(P0.05)。二級(jí)醫(yī)院蛛網(wǎng)膜下腔出血(SAH)患者吸煙史比例明顯高于一、三級(jí)醫(yī)院,一級(jí)醫(yī)院蛛網(wǎng)膜下腔出血(SAH)患者飲酒史比例明顯高于二、三級(jí)醫(yī)院。3、癥狀學(xué)資料：399例患者中各種首發(fā)癥狀的比例為：頭痛(81.7%)、意識(shí)障礙(6.5%)、抽搐(3.8%)、頭暈(2.5%)、枕頸部脹痛(1.8%)、其它表現(xiàn)(3.8%)。經(jīng)統(tǒng)計(jì)學(xué)分析,一級(jí)、二級(jí)、三級(jí)中的SAH癥狀學(xué)比較無統(tǒng)計(jì)學(xué)意義(P0.05)。4、診斷技術(shù)的應(yīng)用：三類不同級(jí)別醫(yī)院均應(yīng)用CT掃描診斷SAH,但發(fā)病后24小時(shí)內(nèi),一、二、三級(jí)醫(yī)院應(yīng)用CT檢查SAH使用率分別為：17.8%、27.5%、42.7%,經(jīng)統(tǒng)計(jì)學(xué)比較,有顯著性差異。其他三個(gè)時(shí)間點(diǎn)(48、72、96小時(shí))無統(tǒng)計(jì)學(xué)差異。應(yīng)用腰椎穿刺診斷SAH,一級(jí)醫(yī)院均未做此項(xiàng)檢查、二級(jí)與三級(jí)醫(yī)院應(yīng)用率也較低(小于5%),未行統(tǒng)計(jì)學(xué)處理。5、病因?qū)W調(diào)查：三類醫(yī)院中,一級(jí)醫(yī)院未能做SAH出血的病因?qū)W檢查,二級(jí)醫(yī)院120例蛛網(wǎng)膜下腔出血患者52例行CTA檢查28例發(fā)現(xiàn)動(dòng)脈瘤(23.3%)。三級(jí)醫(yī)院165例完成CTA(92.7%)、95例完成的DSA(53.4%),共發(fā)現(xiàn)動(dòng)脈瘤124例(69.4%),動(dòng)-靜脈畸形24例(13.4%),其他病因30例(16.8%)。6、治療路徑：一、二級(jí)醫(yī)院均行內(nèi)科治療；三級(jí)醫(yī)院行動(dòng)脈瘤夾閉手術(shù)96例(53.9%),介入填塞47例(26.4%),內(nèi)科治療35例(19.7%)。7、近期預(yù)后：一、二、三級(jí)醫(yī)院1個(gè)月內(nèi)的病死率分別19.8%、23.8%、6.8%;一、二、三級(jí)醫(yī)院預(yù)后良好者分別36.6%、41.7%、69.1%；二項(xiàng)指標(biāo)經(jīng)統(tǒng)計(jì)學(xué)處理有顯著性差異(P0.05)。而且三級(jí)醫(yī)院的不同治療途徑近期預(yù)后相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：湖南地區(qū)三類不同級(jí)別醫(yī)院在蛛網(wǎng)膜下腔出血(SAH)的診斷技術(shù)應(yīng)用、治療路徑的選擇、近期預(yù)后等方面存在明顯的差別。及早確立SAH診斷,及早查明出血病因,同時(shí)及早處理病變血管(結(jié)扎或填塞),這“三個(gè)及早”是改善SAH近期預(yù)后的關(guān)鍵,我國現(xiàn)階段三類不同級(jí)別醫(yī)院均存在較大的提升空間,在一、二級(jí)醫(yī)院尤其突出。
[Abstract]:Objective: To study the difference of the application of three different grade hospitals (primary, secondary, tertiary) and subarachnoid hemorrhage (SAH) in the area of Hunan, and the selection of the treatment route and the short-term prognosis. In order to develop a practical and standardized diagnosis and treatment technology and process for subarachnoid hemorrhage in China, and to provide reference for the investment decision-making of government health resources. Methods: A total of 399 cases of subarachnoid hemorrhage (SAH) in a total of 399 cases of subarachnoid hemorrhage (SAH) were collected from a total of 399 cases of subarachnoid hemorrhage (SAH) during the period from January 2009 to July,2012 by a retrospective analysis. The application of materials, laboratory data, etiology, symptoms, diagnostic techniques, the selection of treatment routes, and the short-term prognosis are investigated and analyzed, and a statistical office The results were as follows:1. Demographic data: There is no significant difference between the data of the three categories (primary, secondary and tertiary) of the subarachnoid hemorrhage (SAH) in the three categories: sex, age, height, body weight and body weight index (P0.05). History of stroke, history of coronary heart disease, history of diabetes, history of hypertension, family history of cerebrovascular disease, and antiplatelet drugs. There were significant differences in the history of smoking and the history of alcohol consumption among the three types of SAH patients (P0. 05) The proportion of the smoking history of the patients with subarachnoid hemorrhage (SAH) in the secondary hospital is significantly higher than that of the first and third-level hospitals, and the proportion of the drinking history of the patients with subarachnoid hemorrhage (SAH) in the first-order hospital is significantly higher than that of the second and third-level hospitals. The ratio was: headache (81.7%), consciousness disorder (6.5%), twitch (3.8%), dizziness (2.5%), pillow neck pain (1.8%), and other performance (3. The results of statistical analysis, primary, secondary, and tertiary SAH symptoms were not statistically significant (P0.05).4. The application of the diagnostic technique: CT scan was used to diagnose SAH in three types of hospitals, but within 24 hours after the onset, the use of CT in one, two, and three-level hospitals was used to check the utilization rate of SAH. The results were: 17.8%, 27.5% and 42.7%, respectively. Sex differences. No statistics for the other three time points (48,72,96 hours) To study the difference, the application rate of the secondary and tertiary hospitals was lower (less than 5%), and no statistical treatment was performed.5. The etiology of the disease: the first-level hospital did not have the cause of SAH bleeding. In the second-stage hospital,52 cases of subarachnoid hemorrhage were examined by CTA and 28 cases were found (23). A total of 165 cases of three-level hospitals (92.7%) and 95 completed DSA (53.4%) were found,124 (69.4%) of the aneurysms,24 (13.4%) of the dynamic-venous malformations,30 (16.8%) of the other causes,6, the treatment route: one and two secondary hospitals for internal medical treatment, and 96 (53) cases of aneurysm clipping in the third-level hospital. In the first, second and third hospitals, the mortality was 19.8%, 23.8% and 6.8%, respectively. The prognosis in the first, second and third-level hospitals was 36.6%, 41.7%,69%, respectively. There was significant difference between the two indexes (P> 0.05). 05) There is a significant difference in the short-term prognosis of different treatment routes of the three-level hospital (P0. 05). Conclusion: There are three types of hospital in Hunan area in the diagnosis of subarachnoid hemorrhage (SAH), the choice of treatment route, the short-term prognosis and so on. Obvious difference. Early establishment of SAH diagnosis, early identification of the cause of the bleeding, and early treatment of the pathological vessel (ligation or packing), the "three early" is the key to improve the short-term prognosis of SAH. At present, there is a large lifting space in three types of hospitals in our country, in one and two-level medical treatment.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.35
本文編號(hào)：2509462
[Abstract]:Objective: To study the difference of the application of three different grade hospitals (primary, secondary, tertiary) and subarachnoid hemorrhage (SAH) in the area of Hunan, and the selection of the treatment route and the short-term prognosis. In order to develop a practical and standardized diagnosis and treatment technology and process for subarachnoid hemorrhage in China, and to provide reference for the investment decision-making of government health resources. Methods: A total of 399 cases of subarachnoid hemorrhage (SAH) in a total of 399 cases of subarachnoid hemorrhage (SAH) were collected from a total of 399 cases of subarachnoid hemorrhage (SAH) during the period from January 2009 to July,2012 by a retrospective analysis. The application of materials, laboratory data, etiology, symptoms, diagnostic techniques, the selection of treatment routes, and the short-term prognosis are investigated and analyzed, and a statistical office The results were as follows:1. Demographic data: There is no significant difference between the data of the three categories (primary, secondary and tertiary) of the subarachnoid hemorrhage (SAH) in the three categories: sex, age, height, body weight and body weight index (P0.05). History of stroke, history of coronary heart disease, history of diabetes, history of hypertension, family history of cerebrovascular disease, and antiplatelet drugs. There were significant differences in the history of smoking and the history of alcohol consumption among the three types of SAH patients (P0. 05) The proportion of the smoking history of the patients with subarachnoid hemorrhage (SAH) in the secondary hospital is significantly higher than that of the first and third-level hospitals, and the proportion of the drinking history of the patients with subarachnoid hemorrhage (SAH) in the first-order hospital is significantly higher than that of the second and third-level hospitals. The ratio was: headache (81.7%), consciousness disorder (6.5%), twitch (3.8%), dizziness (2.5%), pillow neck pain (1.8%), and other performance (3. The results of statistical analysis, primary, secondary, and tertiary SAH symptoms were not statistically significant (P0.05).4. The application of the diagnostic technique: CT scan was used to diagnose SAH in three types of hospitals, but within 24 hours after the onset, the use of CT in one, two, and three-level hospitals was used to check the utilization rate of SAH. The results were: 17.8%, 27.5% and 42.7%, respectively. Sex differences. No statistics for the other three time points (48,72,96 hours) To study the difference, the application rate of the secondary and tertiary hospitals was lower (less than 5%), and no statistical treatment was performed.5. The etiology of the disease: the first-level hospital did not have the cause of SAH bleeding. In the second-stage hospital,52 cases of subarachnoid hemorrhage were examined by CTA and 28 cases were found (23). A total of 165 cases of three-level hospitals (92.7%) and 95 completed DSA (53.4%) were found,124 (69.4%) of the aneurysms,24 (13.4%) of the dynamic-venous malformations,30 (16.8%) of the other causes,6, the treatment route: one and two secondary hospitals for internal medical treatment, and 96 (53) cases of aneurysm clipping in the third-level hospital. In the first, second and third hospitals, the mortality was 19.8%, 23.8% and 6.8%, respectively. The prognosis in the first, second and third-level hospitals was 36.6%, 41.7%,69%, respectively. There was significant difference between the two indexes (P> 0.05). 05) There is a significant difference in the short-term prognosis of different treatment routes of the three-level hospital (P0. 05). Conclusion: There are three types of hospital in Hunan area in the diagnosis of subarachnoid hemorrhage (SAH), the choice of treatment route, the short-term prognosis and so on. Obvious difference. Early establishment of SAH diagnosis, early identification of the cause of the bleeding, and early treatment of the pathological vessel (ligation or packing), the "three early" is the key to improve the short-term prognosis of SAH. At present, there is a large lifting space in three types of hospitals in our country, in one and two-level medical treatment.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.35
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