卒中单元对急性缺血性卒中患者医疗质量和在院预后的影响

doi:10.3969/j.issn.1673-5765.2020.10.008

摘要/Abstract

摘要：

目的调查中国卒中单元对缺血性卒中患者收治的现况，并探索卒中单元对改善卒中医疗质量绩效指标及患者在院预后的影响。方法本研究数据来自中国多中心缺血性卒中住院患者登记研究。按照是否进入卒中单元，将研究对象分为卒中单元组与非卒中单元组。比较两组间患者的卒中医疗质量关键绩效指标（key performance index，KPI）和在院预后（卒中复发、联合血管事件、全因死亡）的差异，并采用多因素回归，分析与卒中单元相关的KPI及卒中单元与缺血性卒中患者在院预后的相关性。结果本研究共纳入了全国1374家医院的269 428例急性缺血性卒中住院患者。其中，63 548例（23.6%）患者纳入卒中单元组。卒中单元与较高比例的rt-PA静脉溶栓（OR 1.48，95%CI 1.43～1.53）、早期抗栓治疗（OR 1.13，95%CI 1.10～1.17）、深静脉血栓预防（OR 1.19，95%CI 1.16～1.22）、吞咽功能筛查（OR 1.36，95%CI 1.32～1.39）、康复评估（OR 1.31，95%CI 1.28～1.34）、出院抗栓治疗（OR 1.12，95%CI 1.08～1.15）、合并心房颤动患者抗凝治疗（OR 1.13，95%CI 1.08～1.19）、戒烟宣教（OR 1.22，95%CI 1.20～1.25）独立相关，与较低的在院卒中复发率（HR 0.79，95%CI 0.75～0.82）和联合血管事件发生率（HR 0.80，95%CI 0.77～0.84）独立相关（均P <0.001）。结论进入卒中单元的缺血性卒中患者，卒中医疗质量KPI完成较好，在院卒中复发率及联合血管事件率较低。

文章导读： 本文通过分析全国缺血性卒中住院患者数据，发现卒中单元能够改善卒中医疗质量关键绩效指标，改善缺血性卒中患者在院结局，但目前我国对卒中单元尚未充分利用。

关键词: 缺血性卒中; 卒中单元; 医疗质量; 关键绩效指标; 预后

Abstract:

Objective To investigate the current status of ischemic stroke patients admitted to stroke units in China, and the effect of stroke unit on the quality of medical care and outcome for acute stroke patients. Methods Data were collected from a national, multi-center inhospital ischemic stroke registry. According to the status of stroke unit, the subjects were divided into stroke unit group and nonstroke unit group. The differences in 11 key performance indexes (KPIs) of stroke medical care and inhospital outcomes (stroke recurrence, composite vascular events, all-cause death) were compared between the two groups. Multivariate regression analysis was used to analyze the correlation between stroke unit and KPIs, and between stroke unit and inhospital outcomes. Results A total of 269 428 inpatients with acute ischemic stroke from national 1374 hospitals were included in this study. Among them, 63 548 patients (23.6%) were included into the stroke unit group. Stroke unit was independently associated with higher proportion of rt-PA intravenous thrombolysis (OR 1.48, 95%CI 1.43-1.53), early antithrombotics (OR 1.13, 95%CI 1.10-1.17), deep venous thrombosis (DVT) prophylaxis (OR 1.19, 95%CI 1.16-1.22), swallowing screening (OR 1.36, 95%CI 1.32-1.39), rehabilitation evaluation (OR 1.31, 95%CI 1.28-1.34), antithrombotics at discharge (OR 1.12, 95%CI 1.08-1.15), anticoagulation for atrial fibrillation (OR 1.13, 95%CI 1.08- 1.19), smoking cessation (OR 1.22, 95%CI 1.20-1.25). In addition, stroke unit was independently associated with a lower rate of stroke recurrence (HR 0.79, 95%CI 0.75-0.82) and composite vascular events (HR 0.80, 95%CI 0.77-0.84) (all P <0.001). Conclusions Patients admitted to stroke unit had better KPIs of stroke medical quality, and had lower recurrence rate and composite vascular event rate during the hospital stay.

Key words: Ischemic stroke; Stroke unit; Medical care; Key performance index; Outcome

张心邈，王春娟，杨昕，谷鸿秋，周奇，王伊龙，赵性泉，李子孝，王拥军. 卒中单元对急性缺血性卒中患者医疗质量和在院预后的影响[J]. 中国卒中杂志, 2020, 15(10): 1073-1077.

ZHANG Xin-Miao, WANG Chun-Juan, YANG Xin, GU Hong-Qiu, ZHOU Qi, WANG Yi-Long, ZHAO Xing-Quan,LI Zi-Xiao, WANG Yong-Jun. Effect of Stroke Unit on the Quality of Medical Care and Inhospital Outcome for Acute Ischemic Stroke Patients[J]. Chinese Journal of Stroke, 2020, 15(10): 1073-1077.

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