Salvesen Rolf, Eldøen Guttorm
Tidsskr Nor Laegeforen. 2013 Sep 17;133(17):1824-7. doi: 10.4045/tidsskr.12.1494.
The regional health enterprises wish to increase the proportion of cerebral infarction patients who receive intravenous thrombolytic therapy. We have identified the reasons why only very few patients received such treatment during 2011-12. We also wished to assess the benefits of ECG telemetry in the examination of the patients.
With permission from the enterprise's own data protection officer, we analysed data for all patients discharged from the stroke unit at the Department of Neurology, Nordland Hospital, after a cerebral infarction (diagnostic code I63) in the period from 1 January 2011 to 30 April 2012.
Of a total of 180 patients admitted directly to the stroke unit, only 12 (6.7%) received intravenous thrombolytic therapy. The main reasons why such treatment was not provided include late arrival at the hospital (n = 91: 50%) and an unknown time of symptom onset (n = 60: 33%). ECG telemetry detected atrial fibrillation in 27 of the 112 patients examined (24%), which meant that anticoagulation treatment was provided to 22 patients who otherwise would have received platelet inhibitors.
Half of all patients with cerebral infarction arrived in the hospital too late for provision of intravenous thrombolytic therapy, and in one-third the time of onset could not be determined. In many patients, ECG telemetry led to changes in the choice of secondary prophylaxis.
地区医疗企业希望提高接受静脉溶栓治疗的脑梗死患者比例。我们已找出2011年至2012年期间仅有极少数患者接受此类治疗的原因。我们还希望评估心电图遥测在患者检查中的益处。
经企业自身数据保护官员许可，我们分析了2011年1月1日至2012年4月30日期间在诺德兰医院神经科卒中单元因脑梗死（诊断代码I63）出院的所有患者的数据。
在直接入住卒中单元的180例患者中，只有12例（6.7%）接受了静脉溶栓治疗。未提供此类治疗的主要原因包括入院时间晚（n = 91：50%）和症状发作时间不明（n = 60：33%）。在接受检查的112例患者中，心电图遥测检测到27例（24%）存在房颤，这意味着22例原本会接受血小板抑制剂治疗的患者接受了抗凝治疗。
所有脑梗死患者中有一半入院时间过晚，无法接受静脉溶栓治疗，三分之一患者的发病时间无法确定。在许多患者中，心电图遥测导致二级预防的选择发生了变化。
