Isifo esibuhlungu ngokukhawuleza yimeko exhomekeke kwixesha. Ukuba kuyenzeka kwisimo sangaphambi kwesibhedlele, iingcali kufuneka zazi ukuba zisiphatha njani isigulana ngeyona ndlela ikhawulezayo kwaye ngokukhawuleza. Nazi iziphumo zesifundo somqhubi eGenova (e-Itali).

Eli nqaku liza kunika ingxelo yovavanyo olukhokelwa nguGqr Andrea Furgani, MD Policlinico San Martino, iGenova ejolise ekuchongeni indlela yokuqonda ngokukhawuleza kunye nokunyanga ukubetha okungalunganga kwindawo yovavanyo kunye nolwahluko okhoyo wovavanyo lwesifo sephepha esibhedlele.

 

Kutheni kubalulekile ukuba zichaze ngokukhawuleza ukubetha kokubini kwisimo sangaphambi kokubeleka kunye nesesibhedlele?

UGqr Furgani, njengalo lonke uluntu lwezenzululwazi, uxela kwisifundo sakhe, ukuba uchonga kwangoko kunye nonyango lwesifo soqhwa kunciphisa ukonakala kwangoko kunye nokukhubazeka kwexesha elide. Umngeni ophumeleleyo kukuchongwa ngokukhawuleza nangokuchanekileyo kwesigulana esine-stroke.

Unyango oluchanekileyo lwe-stroke ebukhali yi-lysis ye-thrombus eyenziwa ngokukhawuleza emva kokuqala. Ukusetyenziswa kwe-EMS, xa kuthelekiswa nentetho ezenzekelayo kwi Igumbi loncedo olukhawulezayo (ER) yesigulane, iphucula imilinganiselo yexesha kunye namanqaku kwii-indexes. Ngokutsho kweNational Institutes of Health Stroke Scale (NIHSS) kunye ne-Barthel Index, ukuthunyelwa kwamaqela ononophelo oluphuthumayo kunokunciphisa iingxaki kunye nokufa. Kwelinye icala, ikwanciphisa ixesha lokulawula izicubu ze-plasminogen activator.

Kwi-2019, izilingo ezininzi zibonise ukusebenza kwe-endovascular therapy (ET) ene-stent retrievers ngokuchaseneyo ne-IV t-PA kuphela kwizigulana ezine-Large Vessel Occlusion (LVO) ethi thaca ngokubanzi i-NIHSS (iZiko leLizwe lezeMpilo yeStroke Scale) elingaphezulu okanye elilinganayo ukuya ku-6.9.

 

Zithini iincwadi malunga noku?

Uncwadi lwangoku lubonisa ukuba imivumbo ichongwa kuphela ngabantu abathatha umnxeba ngokungxamisekileyo malunga nesinye kwisithathu ukuya kwisiqingatha sexesha. UGqr Furgani ucacisa ukuba iStroke Genova Network isebenzisa umnxeba wokuqala "wokutshekisha" owenziweyo kusetyenziswa iMPDS (Inkqubo yoPhuculo oluPhambili lwezoNyango). Ke xa abahlanguli bekunye nesigulana, benza iCincinnati Stroke Scale. Ukuba le "checkpoint" yesibini ilungile, iZiko loNxibelelwano lwezoNyango oluNgxamisekileyo (i-EMCC) lenza i "Stroke Team" ngexesha lothutho esibhedlele.

Ngomnxeba, iqela linxibelelana ngesini kunye nobudala besigulana, ixesha elicingelwayo lokuqala kweempawu, kunye nexesha eliqikelelweyo lokufika. Kubalulekile ukuba inethiwekhi ifumane unxibelelwano phakathi kweZiko eliPhambili lokuThintela ukuHanjiswa kweStroke (SDxT) kunye ne-NIHSS kuba, xa kunokwenzeka, abaguli abane-NIHSS> 10 kufuneka babe phantsi kwe-ET. Ngexesha lokufowuna okungxamisekileyo, kubaluleke kakhulu ukufumana izigulana ezinokubakho nge-NIHSS> 10. Oku kuyakuvumela uthungelwano ukuba luthumele isigulana esibhedlele esikwaziyo ukunika olona nyango lulungileyo, ukugcina ixesha nengqondo (Isibhedlele saseSan Martino, kwimeko IGenova).

Yayisetyenziswa i-MPDS (i-Priority Dispatch Corp. ', inguqulelo ye-MPDS 12.1, 2012, iSalt Lake City, UT, e-USA) ngexesha lokuqokelela ulwazi. IsiQinisekiso soMgangatho woKhuseleko lwezoNyango oluNgxamisekileyo (EMD-Q) siphindaphindwe saza saqwalaselwa, sineenjongo ezimbini ezithile, iimeko zestroke eziqinisekiswe zii-neurologists kodwa ezingaziwa ngexesha lokufowuna okungxamisekileyo. Baqhubeka ngale ndlela ukufumanisa ukuba ingaba iSikhalazo esiyiNtloko esikhethiweyo sasichanekile na (kusetyenziswa iZiko leMfundo leHlabathi eliNgxamisekileyo lokuSasazwa'- IAED ~ -imigangatho, inguqulelo 9a), kunye nokujonga ukuba ingaba ulwazi olukhawulezileyo olunxulumene nokubetha lwabonelelwa ngulowo ufowunayo ngexesha umnxeba. Kubalulekile ukuqwalaselwa kwezifundo zabemi. IGenova 118 EMS igubungela ummandla wabemi abangama-736,235 (52.4% ababhinqileyo) kunye nommandla we-1,127.41 yeekhilomitha (653 zabantu / isikwere sekhilomitha); I-28.2% yabemi abakhonzwayo yiminyaka engama-65 okanye ngaphezulu.

Ngokukhawuleza khomba ukubetha kakhulu. Zithini iziphumo?

Uhlalutyo kunye neeploti baqhuba isoftware ye-SPSS 'Statistics (IBM Corp. ekhutshwe ngo-2016. IBM SPSS Statistics yeWindows, Version 24.0. Armonk, NY: IBM Corp.). Bavavanye ukubaluleka kweenkcukacha-manani besebenzisa uvavanyo lweKruskal-Wallis kwisampulu ezimeleyo, kusetyenziswa inqanaba lokusika elibalulekileyo le-0.05. Uhlalutyo lwexabiso le-NIHSS umndilili, ukuphambuka okuqhelekileyo, kunye nexesha lokuzithemba (Cl) lalisetyenziswa, ngelixa ukuhlalutya kwamaxesha okuphakathi, nge-25th kunye ne-75th yeepesenti ezichazwe kwizibiyeli, zazisetyenziswa.

Phakathi kweziphumo, bafumanisa ukuba i-438 i-stroke ekrokrelwayo ifakwe kwi-registry, iimeko ze-353 (80.6%) ezibizwa ngokuba yi-EMS. Amanye amatyala abandakanya: ukuzibonakalisa, amatyala angama-64 (14.6%); ithunyelwe kwezinye izibhedlele, iimeko ezingama-21 (4.8%). Izigulane ezabiza i-EMS zine-NIHSS ekufikeni kwisibhedlele se-10.9 (Cl: 9.5 - 12.3), ngokuchasene ne-6.0 (Cl: 2.0 - 10.0) yokuzibonakalisa ngokwabo. Uncedo yokuqala, kunye ne-15.1 (Cl: 9.3 - 20.9) kwizigulane ezidluliselwe kwezinye izibhedlele (umzobo 1). Kwizigulane ezibize i-EMS, i-205 (58.1%) ichongiwe njengezibetho ezikrokrelwayo yi-EMD ngexesha lokufowuna ngokukhawuleza.

Kumatyala ashiyekileyo ali-148, kwali-104 ukrokrelo lokuhlaselwa sisifo esenziwe ngu iigulane Abahlanguli, kwaye kwi-44 yezo meko i-Chief Complaint yayilahleka xa kuthunyelwa. Kwiimeko ezingama-104 ezona zikhalazo ziiNtloko zihlala ziGula ngumntu (n = 31, 29.8%), Ukungazi / ukukhuphela (n = 28, 26.9%), Ingxaki engaziwayo (n = 16,15.4%), kunye neePropu (n = 15 ; 14.4%) (Itheyibhile 1). I-SDxT isetyenziswe kwi-129 (62.9%) kwiimeko: i-5 (3.9%) abukho bungqina; I-87 (67.4%) ubungqina beXESHA; 5 (3.9%) BUNGAZI ubungqina; kunye nama-32 (24.8%) BUNGCWELE ubungqina.

Kwiimeko ezingama-76, i-SDxT ayizange isetyenziswe okanye ayigqitywanga. Ixesha lokuqalisa, njengoko kuqokelelwe kwi-SDxT, lahlulwa ngolu hlobo: ngaphantsi kwe-4 iiyure iimeko ezingama-93 (72.1%); phakathi kwe-4 ukuya kwi-6 iiyure iimeko ezi-4 (3.1%); ngaphezulu kweeyure ezi-6 amatyala ali-10 (7.8%); iimeko ezingama-22 ezingaziwayo (17.1%)

Ugqirha wesifo esibhedlele uqinisekisile iimeko ezingama-260 kwezingama-353 (73.7%); kwezi, i-91.5% (n = 238) beziyi-ischemic, kwaye i-8.5% (n = 22) yayiyi-hemorrhagic. Kumatyala angama-205 achongwe yi-EM D, i-154 (75.1%) aqinisekiswa ngoochwepheshe, ngelixa amatyala ayi-104 achongiweyo abahlanguli, i-78 (75.0%) iqinisekisiwe esibhedlele (umzobo 2). Ingxelo yexesha lokuqalisa kweempawu ngexesha lokufowuna ngexesha likaxakeka bekuvumelana nokuvavanywa kwe-neurologist esibhedlele kwiimeko ezingama-58 ze-97 ezibikwe yi-EMD (59.8%); Kumatyala angama-20 aseleyo (iimeko ezi-2 zilahlekile) zachongwa zi-EMDs ngokungaziwa, 65.0% (n = 13) zichongwe esibhedlele njengezenzeka kwiiyure ezi-4.

Ixesha eliqhelekileyo phakathi komnxeba kunye nokufika esibhedlele yayiyimizuzu engama-31 (25 - 43); xa i-EMDs ikrokreleka ukuba ikrokrelwe, ixesha yayiyimizuzu engama-31 (25 - 42), ngelixa ukubetha kwabonwa ngabahlanguli ebaleni yayingu-33 (25 - 44). Akukho mahluko ubalulekileyo wafunyanwa kwisithuba ukusuka ekuqaleni ukuya kuqhagamshelo lokuqala lwe-neurological ukuba ukukrokra ukubetha kwabangelwa zii-EMD okanye abahlanguli: ngokuqatshelwa kwesibetho se-EMD yayiyimizuzu eyi-126.5 (64-316), kwaye ngokuchongwa komhlanguli yayiyimizuzu eyi-120 (64 - 360). Umahluko obalulekileyo wafunyanwa ngexesha lokudibana okokuqala kwe-neurological phakathi kwe-EMS kunye nokuzazisa: imizuzu eyi-123.5 (64 - 329) yezigulana ezibize i-EMS kuthelekiswa nemizuzu engama-317.5 (107 - 2033) yokuzazisa (p <0.000) ( Umzobo 3).

Uphononongo lonxibelelwano phakathi kwe-NIHSS kunye ne-SDxT alufumananga ziphumo zibalulekileyo (2 Table): i-NIHSS kuncedo lokuqala kwizigulana ezinobungqina BESICWANGCISO yayiyi-9.7 (Cl: 7.4 -12.0), ngelixa ubungqina obuQINISEKILEYO okanye obucacileyo yayingu-10.9 ( Cl: 7.3 - 14.4). Amatyala eStroke aqinisekiswe zii-neurologists kodwa engaziwa ngexesha lokufowuna likaxakeka (n = 78) ziye zaphindwa zenziwa ngeenjongo ezimbini ezithile: ukumisela ukuba ngaba iSikhalazo esiyiNtloko esikhethiweyo besichanekile na, kunye nokufumanisa ukuba ngexesha lokufowuna naluphi na ulwazi oluzenzekelayo olunxulumene nokubetha ngofowunayo (Ikhiwane. 4). Kwiimeko ezili-17 (21.8%), bekungekho lula ukufumana ukurekhodwa kwefowuni kaxakeka. Kwimiba engama-61 eseleyo, kumatyala ali-11 (18.0%) isiKhalazo esiyiNtloko ngaphandle kweStroke sikhethwe. Izikhalazo eziNtloko ezikhethiweyo zibandakanya uMntu oGulayo (n = 6, 54.5%), Ukungazi / Ukuphelelwa ngamandla (n = 3, 27.3%) kunye nengxaki engaziwayo (n = 2, 18.2%). Kwi-34 (68.0%) yamatyala angama-50 aseleyo, ngexesha lokudlala kunokwenzeka ukuba uchonge ubuncinci bolunye ulwazi olunikezelwe ngumnxeba ngokubhekisele kwimpawu yokubetha: ukukhankanywa okukodwa kumatyala angama-21 (42.0%), amabini kwali-12 iimeko (24.0%), kwaye ezintathu kwimeko enye (2.0%) (akukho lwazi n = 16, 32.0%). Ulwazi oluzenzekelayo lubandakanya ukukhankanywa kobunzima ekuthetheni (n = 17), iingxaki ngokulinganisela okanye ngokulungelelanisa (n = 11), ubuthathaka okanye ukuphazamiseka (n = 5), intloko ebuhlungu (n = 4), kunye neengxaki ezibonakalayo (n = 3).

Khawuleza uchaze ukubetha okungxamisekileyo: ingxoxo ngeziphumo

Isakhono esihle se-EMD sichongwa ziziphumo. I-58.1% yezigulo zestroke ezithunyelwe esibhedlele ngenxa yokurhanelwa ukubetha kwabonwa zii-EMDs ngexesha lokufowuna okungxamisekileyo. Iziphumo ezifunyenweyo zibonisa indima ephambili yovavanyo olwenziwe "ngobuso ngobuso" ngabahlanguli, abakwazileyo ukufumanisa ukubetha kwi-37.9% yamatyala afundwayo.

Olu phononongo luchonge i-Falls, uMguli, kunye ne-Unconscious / Failing njengezona zikhalazo ziKhulu kwiimeko zezigulana ezinesifo sokuwa esingaziwayo ngexesha lokufowuna okungxamisekileyo. Nokuba umntu ofowunayo uxela uMmangali oyintloko owahlukileyo ekubethweni, uphononongo olucacileyo lweefowuni zongxamiseko lukwabonisa ukuba ulwazi oluzenzekelayo olubhekisa kwiimpawu zesifo sokubetha ngamanye amaxesha lukhona ngexesha lokufowuna.

Ukongeza, ukufikelela esibhedlele nge-EMS ngokubanzi kuqinisekisa ukuphuculwa kwexesha lokunxibelelana ne-neurological okokuqala kwaye, mhlawumbi, nokufikelela kunyango olucacileyo.

 

Khawuleza uchaze ukubetha okungamandla: zithini izithintelo?

Olu luphononongo lokuqhuba, oko kuthetha ukuba kunqunyelwe ngexesha kunye nenani lamatyala. Ngapha koko, iziphumo zitshintshiwe ngenxa yenani elikhulu lamaxabiso ashiyekileyo. Uhlalutyo lwamatyala luqhutywa ngokwemigangatho ye-IAED kuphela kukhetho lweGosa eliyiNtloko. Ukongeza, i-EMD-Q ethe yenza uphononongo yaxelelwa ukuba ezo zigulo zichaphazela abaguli abanokubethwa: oku kunokuba nefuthe kwisigqibo sabo sokukhalaza kwiNtloko eyiNtloko.

kwaye bandise ukubanakho kokuchonga ulwazi oluzenzekelayo olunxulumene nokubetha ngexesha lokudlala. Olu lwazi luvela kwiziko elingeyona i-ACE kwaye lilinganiselwe kwindawo ethile yendawo kunye nenkcubeko (isixeko saseGenova).

 

Iingcamango zokuqukumbela kolu phando ngokubetha kakhulu

I-MPDS ibonise ubuchule bokuchonga izigulana ezinesifo sokuwa ngexesha lokufowuna okungxamisekileyo. Kwicandelo lomnqamlezo elihlaziyiweyo, uninzi lwezigulana ezinesifo esibethayo ekuthiwa yi-EMS (80.6%) zokuhambisa ezibhedlele. Kumatyala angama-205 achongwe yi-EMDs, i-75.1% yaqinisekiswa ngoochwepheshe besifo esibhedlele.

Izifundo ezongeziweyo kufuneka zihlolisise ubunzulu beemeko zokubetha apho ixesha lokuqalisa zabikwa yi-EMD njenge "engaziwayo." I-EMS ngokubalulekileyo inciphisa ixesha phakathi kokuqala kwempawu kunye nokunxibelelana kokuqala kunye nonyango lwe-neurologist. Ukudibana phakathi kwe-SDxT kunye ne-NIHSS kuya kubonakala kuluncedo ekuhlolweni kweefowuni kwizigulana ezine-NIHSSalO, kodwa olu phononongo alunakuchukunyiswa kwesi sihloko.

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FUNDA KUNYE

 

I-Cincinnati Prehospital Stroke Scale. Indima yayo kwiCandelo likaxakeka

 

Azikho iifowuni zongxamiseko kwiimpawu zokubetha, umba wokuba ngubani uhlala yedwa ngenxa yokuvalwa kwe-COVID

 

Ukubaluleka kokutsala inombolo yexesha likaxakeka okanye yelizwe lonke xa unokrokreleka

 

Isiqinisekiso sokukhatshwa sisifo setrokethi seSikhumbuzo seFreemont

 

SOURCE: Uphando