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目的 :介绍急性脑血管病规范化治疗方案和实践的初步结果。方法 :选择上海市 18家三级和二级医院神经科推广该方案的临床治疗效果 ,比较病死率 ,住院时间和各种特殊治疗的临床疗效。结果 :规范化治疗后 ,上海市 18家医院 ( 1998年 6月～ 2 0 0 0年 5月 ) 6743例脑梗死 ,总病死率 4 92 % ,较规范化治疗前下降 18 3 % ;脑出血 192 4例 ,较规范化治疗前下降 3 5 9% ,住院时间从平均3 7 3d下降到 2 5 7d ,缩短 3 1 1%。特殊规范治疗显示 ,静脉溶栓治疗改善 14d神经功能和 2 1dADL ;抗凝治疗改善 14、2 1d神经功能和 2 1dADL ;降纤治疗改善 14d神经功能和 2 1dADL ,但各种治疗均未改善第 90天的ADL。结论 :规范化治疗可以降低脑卒中的急性期病死率 ,改善近期神经功能和ADL ,但尚不能改变远期ADL结果。
Objective: To introduce the preliminary results of standardized treatment and practice of acute cerebrovascular disease. Methods: The clinical efficacy of this regimen was evaluated in 18 tertiary and secondary hospitals in Shanghai. The mortality, hospital stay and clinical effects of various special treatments were compared. Results: After standardized treatment, 6743 cases of cerebral infarction were found in 18 hospitals in Shanghai (June 1998 ~ May 2000) with a total case fatality rate of 4 92%, which was 18 3% lower than that before the standardization treatment. Cerebral hemorrhage 192 4 For example, a decrease of 35 59% from the standardization treatment and a decrease of 31.1% in hospitalization time from an average of 37 days to 257 days. Specific normative treatment showed that intravenous thrombolysis improved neurological function for 14 days and 21dADL; anticoagulation therapy improved neurological function on 14,21d and 21dADL; fibrinolytic therapy improved neurological function on 14th day and 21dADL, but all kinds of treatment did not improve 90 days ADL. Conclusion: Standardized treatment can reduce the acute mortality rate of stroke and improve the recent neurological function and ADL, but it can not change the long-term ADL outcome.