二甲与三甲医院轻型缺血性脑卒中诊疗现状的对照研究

Comparative Study on the Diagnosis and Treatment of Mild Ischemic Stroke in Second-Class and Third-Class Hospitals

摘要: 目的：分析区县级二甲医院(莱西市市立医院)及地区大三甲医院(青岛大学附属医院)轻型缺血性脑卒中患者的诊疗现状，比较两者诊疗规范性及复发率的差异。方法：收集2021年1月~2021年12月莱西市市立医院神经内科及青岛大学附属医院神经内科接诊轻型缺血性脑卒中(NIHSS ≤ 5分)患者的临床资料。比较两家医院患者的基线资料，包括：性别、年龄、NIHSS评分、TOAST分型、以及是否合并高血压病、糖尿病、高脂血症和同型半胱氨酸血症等。评估两家医院药物治疗的规范情况，并对两家医院该类患者的卒中复发率进行比较。结果：性别、高血压病、糖尿病、同型半胱氨酸血症、NIHSS评分两家医院无统计学差异，年龄、高脂血症及TOAST分型两家医院有统计学差异。莱西市市立医院予以规范药物治疗167人，治疗不规范患者112人；青岛大学附属医院370人均予以规范药物治疗，两者具有统计学差异。临床随访显示，莱西市市立医院卒中复发38人(15.5%)，青岛大学附属医院复发14人(4.0%)，两者具有统计学差异。结论：区县级二甲医院(莱西市市立医院)与地区大三甲医院(青岛大学附属医院)在轻型缺血性脑卒中药物治疗的规范性方面有较大差距，且前者的卒中复发率较后者更高。

Abstract: Objective: To analyze the current status of diagnosis and treatment of minor ischemic stroke at secondary level county hospitals (Laixi City Hospital) and major tertiary hospitals in the region (Qingdao University Affiliated Hospital), and to compare the differences in the standardization of diagnosis and treatment and the recurrence rate between the two. Methods: Clinical data of patients with minor ischemic stroke (NIHSS ≤ 5) who were admitted to the Department of Neurology at Laixi City Hospital and Qingdao University Affiliated Hospital from January 2021 to December 2021 were collected. Baseline data of patients from both hospitals were compared, including: gender, age, NIHSS score, TOAST classification, and comorbidities such as hypertension, diabetes, hyperlipidemia, and homocysteinemia. The standardization of pharmacological treatment at both hospitals was assessed, and the recurrence rates of stroke in such patients at both hospitals were compared. Results: Gender, hypertension, diabetes, hyperhomocysteinemia, and NIHSS scores showed no statistical difference between the two hospitals, while age, hyperlipidemia, and TOAST classification did show statistical differences. Laixi City Hospital treated 167 patients with standard medication, while 112 patients received non-standard treatment; all 370 patients at Qingdao University Affiliated Hospital received standard medication treatment, showing a statistical difference between the two. Clinical follow-ups indicated that stroke recurrence occurred in 38 patients (15.5%) at Laixi City Hospital and in 14 patients (4.0%) at Qingdao University Affiliated Hospital, demonstrating a statistical difference between the two. Conclusion: There is a significant gap in the standardization of pharmacological treatment for minor ischemic stroke between secondary level county hospitals (Laixi City Hospital) and major tertiary hospitals in the region (Qingdao University Affiliated Hospital), with the former having a higher rate of stroke recurrence compared to the latter.