缺血性腦卒中就醫延遲的概念分析

Delay in seeking medical attention in patients with ischemic stroke：a concept analysis

LEI Wanying，GUO Lina，PAN LanxiaSchool of Nursing，Henan University of Traditional Chinese Medicine，Henan 450046 ChinaCorresponding Author PAN Lanxia，E-mail：panlanx@163.com

Abstract Objective：To define the concept of delay in seeking medical attention for ischemic stroke.Methods：The literature related to delayed in seeking medical attention for ischemic stroke patients was retrieved from CNKI，VIP，WanFang Database，Web of Science，PubMed，the retrieval time was from the inception to October 30，2023.The Rodgers evolutionary concept analysis method was used to analyze the literature.Results：8 antecedent variables including remote residence，failure to call emergency ambulance，stroke depression，financial constraints，early postoperative period，symptom recognition and severity judgment，racial differences，and living alone and 3 attributes including severe decision-making delay，not easy to identify，and strong sense of disease stigma were summarized.Conclusion：Deepening the analysis of the concept of delayed in seeking medical attention in ischemic stroke not only improves the science and comprehensiveness of the measurement scale prepared by medical workers，but also guarantees the objectivity and accuracy of the assessment of the risk of delayed in seeking medical attention by medical workers.By defining the concept of delayed in seeking medical attention in ischemic stroke，medical workers can take timely and effective interventions to control the incidence of delayed in seeking medical attention in the minimum range，and finally improving the prognosis and quality of life of patients with ischemic stroke.

Keywords ischemic stroke;delay in seeking medical attention;concept analysis;nursing

摘要 目的：對缺血性腦卒中就醫延遲的概念進行界定。方法：計算機檢索中國知網、維普數據庫、萬方數據庫、Web of Science、PubMed等數據庫中缺血性腦卒中病人就醫延遲的相關文獻，檢索時限為建庫至2023年10月30日，采用Rodgers演化概念分析法進行分析。結果：歸納出居住地偏遠、未呼叫救護車、腦卒中抑郁、經濟拮據、術后早期、癥狀識別與嚴重程度判斷、種族差異、獨居8個前因變量，決策延遲嚴重、不易鑒別、病恥感強烈3個屬性。結論：深入分析缺血性腦卒中就醫延遲的概念，不僅提升了醫務工作者編制的測評量表的科學性和全面性，也保障了醫務工作者就醫延遲危險度評估的客觀性和準確性，便于醫務工作者及時采取有效的干預措施，將就醫延遲發生率控制在最小范圍內。

關鍵詞 缺血性腦卒中；就醫延遲；概念分析；護理

doi：10.12102/j.issn.2095-8668.2024.19.001

2019年全球疾病負擔研究數據顯示，我國人群腦卒中發病率為276.7/10萬，遠超世界其他國家［1］。腦卒中是臨床最常見的腦血管疾病，具備“四高特性”，即高致病率、高復發率、高致殘率、高死亡率。其中，缺血性腦卒中（ischemic stroke，IS）的比例高達87％［2］。目前，缺血性腦卒中的緊急處理要點是再灌注治療，包括靜脈溶栓（intravenous thrombolysis，IVT）和血管內介入治療（endovascular therapy，EVT），這兩種治療方法對治療時間均有嚴格要求［3-4］。目前，公認的標準是4.5 h內行IVT、24 h內行EVT，且治療時間越早，獲益越大［5-6］。然而既往研究顯示，缺血性腦卒中病人在就醫、診斷、治療等方面普遍存在延遲，發病至檢查診斷平均時間達到了4.5 h［7-8］。缺血性腦卒中治療延遲時間與死亡率和致殘率的增加有關，由于延遲就醫，病人腦組織梗死面積持續擴大，產生不可逆的損害?！?br>