Prehospitalno kašnjenje pacijenata sa znacima akutnog moždanog udara

Ključne reči: akutni ishemijski moždani udar, primarna zdravstvena zaštita, hitna medicinska pomoć

Sažetak


Uvod. Akutni moždani udar je drugi vodeći uzrok smrti i treći vodeći uzrok invaliditeta u svetu. Osnovni cilj u lečenju je da pacijent u prva 4,5h od pojave simptoma dobije trombolitičku terapiju. Većina pacijenata prve simptome doživi izvan zdravstvenih ustanova, tako da je važno prepoznavanje oboljenja od strane prisutnih osoba. Teži moždani udari, korišćenje vozila Hitne medicinske pomoći i mlađe životno doba udruženi su sa smanjenjem prehospitalnog kašnjenja.
Cilj rada. Prikazati koliko je prehospitalno kašnjenje pacijenata koji imaju tegobe koje ukazuju na moždani udar, i taj uticaj na lečenje.
Metod. Istraživanje je studija preseka rada ambulante Hitne medicinske pomoći Beograd u periodu od 1.1.2015. do 31.12.2018 god. sa pacijentima kojima je postavljena dijagnoza Cerebrovaskularni insult CVI, sumnja na CVI, Tranzitorni ishemični atak. Prehospitalno kašnjenje je vreme od pojave tegoba do trenutka javljanja lekaru. Pacijenti su podeljeni u grupe prema kašnjenju: do 3h, 3-24h i više od 24h. Statistička obrada je izvršena u programu SPSS 11, a statistička značajnost je definisana na nivou p<0,05.
Rezultati. U istraživanju je učestvovalo 119 ispitanika prosečne starosti 65,53±14,24 godina, muškog pola 46,22%, ženskog pola 53,78%. U prva tri sata od početka tegoba u ambulantu je stiglo 44,54%, u vremenu od 3-24h - 31,93%, a preko 24h - 23,53% pacijenata.
Zaključak. Više od polovine pacijenata se javlja u vremenu kada savremena trombolitička terapija nije efikasna.

Biografija autora

Slavoljub R Živanović, Gradski zavod za hitnu medicinsku pomoć Beograd

Specijalista opšte medicine i subspecijalista gerontologije

Reference

Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bull World Heal Organ. 2016;

Republička stručna komisija za izradu i implementaciju vodiča dobre kliničke prakse. Nacionalni vodič dobre kliničke prakse za dijagnostikovanje i lečenje ishemijskog moždanog udara [Internet]. 2012 [cited 2020 Jul 14]. Available from: http://www.drustvoneurologasrbije.org/vodici/Vodic za dijagnostikovanje i lecenje ishemijskog mozdanog udara.pdf

Faiz KW, Sundseth A, Thommessen B, Rønning OM. Prehospital delay in acute stroke and TIA. Emerg Med J [Internet]. 2013 Aug [cited 2020 Jun 30];30(8):669–74. Available from: https://pubmed.ncbi.nlm.nih.gov/22886891/

Rose KM, Rosamond WD, Huston SL, Murphy C V., Tegeler CH. Predictors of time from hospital arrival to initial brain-imaging among suspected stroke patients: The North Carolina collaborative stroke registry. Stroke [Internet]. 2008 Dec 1 [cited 2020 Jun 30];39(12):3262–7. Available from: https://pubmed.ncbi.nlm.nih.gov/18688010/

Montiel-Luque A, Núñez-Montenegro AJ, Martín-Aurioles E, Canca-Sánchez JC, Toro-Toro MC, González-Correa JA, et al. Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy. Quinn TJ, editor. PLoS One [Internet]. 2017 Feb 6 [cited 2018 Dec 9];12(2):e0171320. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28166266

Ministarstvo zdravlja republike Srbije, repubička stručna komisija za izradu i implementaciju vodiča dobre kliničke prakse, Akutni ishemijski moždani udar. 2004. [Internet]. [cited 2020 Jul 14]. Available from: https://www.zdravlje.gov.rs/view_file.php?file_id=690&cache=sr

Fladt J, Meier N, Thilemann S, Polymeris A, Traenka C, Seiffge DJ, et al. Reasons for Prehospital Delay in Acute Ischemic Stroke. J Am Heart Assoc [Internet]. 2019 Oct 15 [cited 2020 Jun 30];8(20). Available from: https://www.ahajournals.org/doi/10.1161/JAHA.119.013101

Dolmans LS, Hoes AW, Bartelink MLEL, Kappelle LJ, Rutten FH. Determinants of Patient Delay in Transient Ischemic Attack. Eur Neurol [Internet]. 2019 Aug 1 [cited 2020 Sep 22];81(3–4):139–44. Available from: https://pubmed.ncbi.nlm.nih.gov/31212275/

Seno S, Tomura S, Ono K, Akitomi S, Sekine Y, Yoshimura Y, et al. The Relationship between Functional Outcome and Prehospital Time Interval in Patients with Cerebral Infarction. J Stroke Cerebrovasc Dis [Internet]. 2017 Dec 1 [cited 2020 Sep 22];26(12):2800–5. Available from: https://pubmed.ncbi.nlm.nih.gov/28774793/

Schlemm L, Endres M, Nolte CH. Bypassing the closest stroke center for thrombectomy candidates what additional delay to thrombolysis is acceptable? Stroke [Internet]. 2020 [cited 2020 Jun 30];51(3):867–75. Available from: https://pubmed.ncbi.nlm.nih.gov/31964288/

Pulvers JN, Watson JDG. If time is brain where is the improvement in prehospital time after stroke? [Internet]. Vol. 8, Frontiers in Neurology. Frontiers Media S.A.; 2017 [cited 2020 Jun 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/29209269/

Yanagida T, Fujimoto S, Inoue T, Suzuki S. Prehospital delay and stroke-related symptoms. Intern Med. 2015 Jan 15;54(2):171–7.

Denti L, Caminiti C, Scoditti U, Zini A, Malferrari G, Zedde ML, et al. Impact on prehospital delay of a stroke preparedness campaign a SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial). Stroke [Internet]. 2017 [cited 2020 Jun 30];48(12):3316–22. Available from: https://pubmed.ncbi.nlm.nih.gov/29101258/

Faiz KW, Sundseth A, Thommessen B, Rønning OM. The knowing-doing gap in acute stroke—Does stroke knowledge translate into action? [Internet]. Vol. 9, Brain and Behavior. John Wiley and Sons Ltd; 2019 [cited 2020 Jun 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/30790476/

Shaw L, Price C, McLure S, Howel D, McColl E, Ford GA. Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): Study protocol for a pilot randomised controlled trial. Trials. 2011 Jun 15;12:152.

Emiš-Vandlik N, Bogunović S, Gemišov-Nikolić F, Anđelić S. Prehospital diagnostic procedures in patients with acute ischemic stroke. Naučni časopis Urgent Med - Halo 194. 22(3):362–9.

Lu H, Guo Z, Liu J, Zhang H, Zhao W, Wu Y, et al. Trends in stroke incidence among elderly low-income residents of rural China: A population-based study from 1992 to 2016. Aging (Albany NY) [Internet]. 2018 Nov 1 [cited 2020 Feb 21];10(11):3438–49. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30487317

Rossnagel K, Jungehülsing GJ, Nolte CH, Müller-Nordhorn J, Roll S, Wegscheider K, et al. Out-of-hospital delays in patients with acute stroke. Ann Emerg Med. 2004 Nov 1;44(5):476–83.

Ragoschke-Schumm A, Walter S, Haass A, Balucani C, Lesmeister M, Nasreldein A, et al. Translation of the “time is brain” concept into clinical practice: focus on prehospital stroke management. Int J Stroke [Internet]. 2014 Apr [cited 2020 Feb 11];9(3):333–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24593156

Jiang B, Ru X, Sun H, Liu H, Sun D, Liu Y, et al. Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. Sci Rep. 2016 Jul 14;6.

Fekadu G, Wakassa H, Tekle F. Stroke Event Factors among Adult Patients Admitted to Stroke Unit of Jimma University Medical Center: Prospective Observational Study. Stroke Res Treat [Internet]. 2019 [cited 2021 Jul 4];2019. Available from: https://pubmed.ncbi.nlm.nih.gov/30854184/

Giles MF, Flossman E, Rothwell PM. Patient behavior immediately after transient ischemic attack according to clinical characteristics, perception of the event, and predicted risk of stroke. Stroke [Internet]. 2006 May [cited 2020 Jun 30];37(5):1254–60. Available from: https://pubmed.ncbi.nlm.nih.gov/16574923/

Arulprakash N, Umaiorubahan M. Causes of delayed arrival with acute ischemic stroke beyond the window period of thrombolysis. J Fam Med Prim Care [Internet]. 2018 [cited 2020 Jun 30];7(6):1248. Available from: https://pubmed.ncbi.nlm.nih.gov/30613505

Objavljeno
2021/11/01
Kako citirati
Živanović, S. R. (2021). Prehospitalno kašnjenje pacijenata sa znacima akutnog moždanog udara. Opšta Medicina, 27(3-4), 53-60. https://doi.org/10.5937/opmed27-33882
Rubrika
originalni rad