| Objectives:In recent years,with the deepening of the stroke prevention and treatment project by the National Health Commission of China,the acute ischemic stroke treatment technology has been promoted,and the ability to treat is continuously improved.But the problem of delayed visits in patients with acute ischemic stroke is outstanding.Most patients miss the best therapeutic time window because they have not been admitted to hospital.It has become the biggest bottleneck affecting the treatment of acute ischemic stroke.The purpose of this study was to investigate the delayed visits and prognosis of patients with acute ischemic stroke,to analyze the influencing factors and consequences of delayed visits,to develop appropriate nursing strategies,and to provide a theoretical basis for health education on stroke-related disease knowledge.Methods:1.Self-designed structured questionnaire,one-on-one questionnaire survey of 230 patients with acute ischemic stroke in the Sixth Affiliated Hospital of Kunming Medical University.Analyze the influencing factors of delayed visits.2,The follow-up study was conducted 6 months after the onset of the disease.Follow-up by telephone to understand the survival status and recurrence of the respondents 6 months after onset.3.According to the results of the investigation and analysis,study the nursing strategies to solve the problem of delayed visits of patients with acute ischemic stroke.Results:1.A total of 230 patients with acute ischemic stroke were enrolled in the study.74 patients visited within 4.5 hours,32.2%of the total,and the delayed visit rate was 67.8%.The delay time of the decision is 896.07±1761.24 minutes,P25=0.00(minutes),P50=90.00(minutes),P75=900.00(minutes).The delay time of the road is 704.70±1556.33 minutes,P25=48.75(minutes),P50=120.00(minutes),P75=408.75(minutes).The time from onset to arrive at the hospital was 1600.77±2141.75 minutes,P25=195.00(minutes),P50=625.00(minutes),P75=2055.00(minutes).2.Univariate analysis shows that some patients with acute ischemic stroke had a higher rate of delayed visits,for instance,younger age,first-time symptoms of limb numbness,earliest symptoms found by the patient,no one around at the time of onset,no awareness of stroke at the time of onset,low NIHSS score,taking self-treatment or waiting for symptom relief after the onset,worrying about the cost,after referral,admission through the outpatient service,never heard of the stroke,do not know that stroke needs to be treated as soon as possible,lower stroke recognition scores.However,patients who live in suburban areas,have dyslipidemia,have heart disease,have first-time symptoms of speech disorders or dizziness or disturbance of consciousness,or incidence in the suburbs have a lower rate of delayed visits.Logistic regression analysis showed that the factors affecting delayed visits in patients with acute ischemic stroke includes past physical health,dyslipidemia,heart disease,the earliest person who discovered the symptoms,awareness of stroke at the time of onset,measures taken,whether or not first visit.admission NIHSS score,admission route.3.Follow-up survey of subjects after 6 months of onset.A total of 200 people were investigated,and the rate of loss of follow-up was 15.0%.22 of the 200 follow-ups(11.0%)died,17 of whom died of cerebrovascular disease,two died of other diseases or accidents,and three others were unknown.Among the non-dead follow-ups,107(53.5%)had stroke sequelae,eight(4.0%)had recurrent ischemic stroke,and six(3.0%)admitted to hospital for other cerebrovascular diseases other than ischemic stroke.Onset to door time and admission HINSS score had a statistically significant effect on the prognosis of patients with acute ischemic stroke.Conclusions:1.The delayed treatment of patients with acute ischemic stroke is serious,and the prognosis is poor.2.Factors affecting delayed visits in patients with acute ischemic stroke include:age,place of residence,dyslipidemia,heart disease,first symptom,place of onset,the earliest person who discovered the symptoms,whether have anyone around when the patient is sick,whether aware of the stroke at the time of onset,admission NIHSS score,measures taken after onset,whether worried about the cost,admitted through emergency department or outpatient service,stroke cognitive level.3.The main factors affecting the prognosis of patients with acute ischemic stroke are onset to door time and admission NIHSS score.4.In view of the existing problems,we propose the following countermeasures:screening and intervening in high-risk groups of stroke in hospitals;screening and intervening for high-risk populations of residents with stroke;follow-up interventions for high-risk groups of stroke;promoting strock health education to county towns,towns and villages;strengthen the strock health education of strokes of incumbents;strengthen health education for family members of people at high risk of stroke;researching and developing stroke health education content suitable for the region;selecting appropriate strock health education media;train"stroke health manager";training grassroots hospital medical staff;training medical staff in emergency centers.At the same time,we hope that the government will increase capital investment and reduce the economic burden of AIS patients. |
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