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["“决定并行动!”院前护理人员在减少中风诊断患者时间损失方面的作用"]

[“Decide and run!” The role of prehospital care providers in reducing time loss for patients with stroke diagnosis].

作者信息

Schiszler Bence, Pandur Attila, Priskin Gábor, Tóth Balázs, Betlehem József, Radnai Balázs

机构信息

1 Pécsi Tudományegyetem, Egészségtudományi Kar, Sürgősségi Ellátási és Egészségpedagógiai Intézet, Oxyológiai, Sürgősségi Ellátási Tanszék Pécs, Rodostó u. 28. A/2., 7624 Magyarország.

2 Pécsi Tudományegyetem, Egészségtudományi Kar, Sürgősségi Ellátási és Egészségpedagógiai Intézet Pécs Magyarország.

出版信息

Orv Hetil. 2022 Feb 13;163(7):279-287. doi: 10.1556/650.2022.32351.

Abstract

Introduction: When treating stroke patients, the aim should be to get the patient to a specialist stroke centre as soon as possible. Objective: In our study, in order to be able to stay within the therapeutic window, we investigated which variables affect the time period of prehospital treatment. Method: For our cross-sectional quantitative study, we gathered data from two ambulance stations in Hungary, comparing the competence of physician and non-physician units. We processed information from 2017 regarding patients whose initial diagnosis was stroke (n = 220). We examined how investigations by the ambulance unit, symptoms experienced and therapeutic time window have affected prehospital times. As for the statistic software, we used SPSS 26.0. The analysis was conducted by performing χ2 test, F-test and T-test. Results: We identified that if the aphasia component of the used score system was positive, the on-scene time increased significantly (p = 0.003). In the D section of the rapid ABCDE assessment, it is mandatory to measure the blood glucose level of the patient, however, in our sample it was omitted in 25.45% of the cases. We identified that on-site blood glucose measurement has an effect on prehospital delay for non-physician units (p<0.001). Conclusion: We found that the on-scene time is longer for physician units than for non-physician units. We concluded that motor or sensory aphasia does not affect the therapy, it is just one of the symptoms that can increase the likelihood of stroke diagnosis, therefore prolonging time for assessing aphasia in the field should be avoided. Moreover, it is recommended to make care providers aware of this during training sessions. Improvements are required in non-physician units to reduce the time consumed by blood glucose measurement, as it has been shown that within physician units this test does not appear to be a delay-causing factor. Orv Hetil. 2022; 163(7): 279–287.

摘要

引言

治疗中风患者时,目标应是尽快将患者送至专业的中风中心。目的:在我们的研究中,为了能够处于治疗窗内,我们调查了哪些变量会影响院前治疗的时间。方法:对于我们的横断面定量研究,我们从匈牙利的两个救护站收集数据,比较医生单元和非医生单元的能力。我们处理了2017年有关初始诊断为中风的患者(n = 220)的信息。我们研究了救护单元的检查、所经历的症状和治疗时间窗如何影响院前时间。至于统计软件,我们使用了SPSS 26.0。通过进行χ2检验、F检验和T检验进行分析。结果:我们发现,如果所用评分系统的失语症部分为阳性,现场时间会显著增加(p = 0.003)。在快速ABCDE评估的D部分,必须测量患者的血糖水平,然而,在我们的样本中,25.45%的病例中该检查被遗漏。我们发现现场血糖测量对非医生单元的院前延迟有影响(p<0.001)。结论:我们发现医生单元的现场时间比非医生单元长。我们得出结论,运动性或感觉性失语不影响治疗,它只是可增加中风诊断可能性的症状之一,因此应避免在现场延长评估失语症的时间。此外,建议在培训课程中让护理人员了解这一点。非医生单元需要改进以减少血糖测量所消耗的时间,因为已表明在医生单元中该检查似乎不是导致延迟的因素。《匈牙利医学周报》。2022年;163(7): 279–287。

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