中文摘要：

目的了解和分析脑卒中患者院内急诊救治延迟现状及其影响因素,总结脑卒中院内急诊救治存在的问题与不足,提出优化急诊救治流程的策略和建议。方法选取广州医科大学附属第一医院2012—2014年经急诊入院的903例脑卒中患者。采用自行设计的调查表,现场追踪登记患者院内各项检查的时间;采用访谈法,以院内急诊救治为核心,对6名脑卒中急救医务人员进行半结构化访谈;采用多因素Logistic回归分析影响院内急诊救治延迟的因素。结果 903例脑卒中患者中,脑梗死669例（74.09%）,由出租车/私家车/公交车等交通工具自行入院827例（91.58%）,出现救治延迟570例（63.12%）。不同年龄段脑卒中患者院内急诊救治延迟情况比较,差异有统计学意义（χ^2=9.515,P=0.023）。就诊至生命体征管理时间、就诊至病史采集时间、就诊至体格检查时间、就诊至心电图检查时间、就诊至获取血样时间、就诊至神经功能评估时间、就诊至完成CT扫描时间、就诊至开始治疗时间分别与美国国立神经疾病与卒中研究所（NINDS）标准时间比较,差异均有统计学意义（P〈0.01）。患者院内急诊救治CT检查环节（开始CT检查至获取CT报告）中位用时43 min,占总用时51.19%;体温管理环节中位用时14 min,占总用时16.67%;神经功能评估环节中位用时12 min,占总用时14.29%。多因素Logistic回归分析结果显示,年龄〔OR=1.023,95%CI（1.011,1.036）〕、入院方式〔OR=0.487,95%CI（0.270,0.879）〕和是否行CT检查〔OR=1.887,95%CI（1.373,2.594）〕是脑卒中院内急诊救治延迟的影响因素。访谈定性评价显示,目前急诊科脑卒中急诊救治流程需要大革命式的改进。结论广州地区脑卒中患者院内急诊救治延迟现象较严重,应针对院内救治延迟的影响因素,进一步规范就诊流程,缩短脑卒中院内急诊救治时间。

英文摘要：

Objective To understand and analyze the delayed status of in-hospital emergency treatment and its influencing factors of patients with stroke,to summarize the key problems and shortcomings of the emergency treatment of stroke in the hospital,and to put forward the strategies and suggestions to optimize the emergency treatment process.Methods A total of903 patients with stroke,admitted after emergency treatment in the First Affiliated Hospital of Guangzhou Medical University from2012 to 2014,were selected in the study.Self-designed questionnaire was used to trace and record the time of various checks of the patients in the hospital.Taking the in-hospital emergency treatment as the core,interviewing method was applied to conduct semi-structured interviews for 6 medical staff giving first-aid treatment to patients with stroke, and multivariate Logistic regression analysis was used to analyze the factors affecting the delay in emergency treatment in the hospital.Results Of the 903 patients with stroke,669（74.09%） had cerebral infarction; 827（91.58%） arrived at hospital by taxi/private car/bus; and treatment for 570（63.12%） were delayed.There was significant difference in the status of in-hospital emergency treatment delay of stroke patients of different age（χ^2= 9.515,P = 0.023）.The time from seeking treatment to management of vital signs,from seeking treatment to history-taking, from seeking treatment to physical examination, from seeking treatment to electrocardiographic examination,from seeking treatment to collecting blood samples,from seeking treatment to nervous system evaluation,from seeking treatment to finishing CT scanning,from seeking treatment to starting treatment and the standardized time of NINDS were significantly different（P〈0.01）.The median time of CT examination（time from beginning of the CT examination to the obtaining of CT report） of patients in emergency treatment in the hospital was 43 min,covering 51.19% of the total time.The median time of temperature management wa