POJAVNOST, ISHODI I TERAPIJA ISHEMIJSKOG CEREBROVASKULARNOG INCIDENTA U OPĆOJ ŽUPANIJSKOJ BOLNICI POŽEGA TIJEKOM 2017. GODINE ; APPEARANCE, OUTCOME AND THERAPY OF ISCHEMIC CEREBRAL VASCULAR INCIDENT AT THE GENERAL COUNTY POŽEGA HOSPITAL DURING 2017
Uvod: Moždani udar ima visoku smrtnost kako u svjetskim okvirima tako i kod nas. Značajno financijski opterećuje kako republički tako i županijske zavode za zdravstveno osiguranje. Glavnina bolesnika ostaje trajnim invalidima, a uz velika financijska izdvajanja i upornu fizikalnu terapiju oporavi se mali broj bolesnika (jedna trećina). Osim medicinskog osoblja koje sudjeluje u tretmanu bolesnika oboljelih od MU, veliku ulogu u oporavku imaju obitelj i bolesnikovo šire i daljnje okruženje. Cilj rada: je utvrditi broj i distribuciju bolesnika liječenih od moždanog udara u 2017. godini, procijeniti ishode liječenja te utvrditi vrstu antikoagulantne terapije na otpustu. Definirati i analizirati faktore rizika s osvrtom na primarnu i sekundarnu prevenciju. Procijeniti postojeću skrb bolesnika, uz definiranje mjesta i uloge medicinske sestre. Metode: Ciljni parametri prikupljeni su iz medicinske dokumentacije koja je nastala tijekom liječenja bolesnika. Varijable, prikupljene iz elektronskih otpusnih pisama unesene su u elektronički zapis ispitanika u program Microsoft Excel, po posebno izrađenoj tablici podataka. Rezultati: Sudjelovalo je 167 bolesnika, 86 žena (51,50%) i 81 muškaraca (48,50%). Najzastupljeniji faktori rizika bili su hiperlipidemija i hipertenzija, fibrilacija atrija i dob iznad 70 godina. Od moždanog udara 2017. god. umrlo je 45 bolesnika (26,90%), više muških (53,30%), s neurološkim deficitom ostalo je 56 bolesnika (33,50%), više muških (53,60%), a djelomično ili potpuno oporavljenih je bilo 66 (27,00%), više kod žena (59,00%). U tretmanu fibrilacije atrija (67,00%), mali dio bolesnika je na Warfarinu i NOACs, 88 njih (52,30%) u odnosu na 134 na acetilsalicilnoj kiselini (80,20%). Postoji statistički značajna razlika u vrsti i broju čimbenika rizika MU u odnosu na dob i spol ispitanika. Stariji bolesnici skloniji su većoj smrtnosti. Muški spol je faktor rizika i među muškarcima veća je ukupna smrtnost. Zaključak: Prepoznavanje i sustavno provođenje politike unaprjeđenja i očuvanja zdravlja uz aktivnosti na području primarne, specijalističke i bolničke zdravstvene zaštite osnovni su preduvjeti postizanja uspjeha u prevenciji moždanog udara. U stvaranju takvog okruženja nužna je suradnja zdravstva s drugim strukturama javnog života. ; Introduction: Stroke has high mortality both in the world and in us. Significantly financially burdens both the republic and county health insurance bureaus. The majority of the patients remain with permanent invalids, and with a small amount of financial resources and persistent physical therapy, a small number of patients (one-third) recover. In addition to the medical staff involved in the treatment of patients with MU, a major role in recovery has the family and the patient's wider and further environment. Aim: The aim of the study was to determine the number and distribution of stroke patients in 2017, to evaluate the outcomes of the treatment and to determine with whom the patients were relieved from the department (antiagregation, new oral anticoagulants, warfarin). Also, risk factors will be defined and analyzed with reference to primary and secondary stroke prevention. Existing patient care will be evaluated, along with the definition of the nurses' place and role in the treatment of this type of patient. Methods: Target parameters were collected from medical documentation that was generated during patient treatment. Variables, collected from electronic resignation letters were submitted to the electronic record of the respondents in the Microsoft Excel program by a specially made data table. Results: A total of 167 patients, 86 women (51.50%) and 81 males (48.50%) participated in the study. The most frequent risk factors were hyperlipidemia and hypertension, more frequent in the male population, while atrial fibrillation and age over 70 were more common in women. From a stroke in 2017, 45 patients (26.90%), more males (53.30%) died, with 56 (33.50%), more male (53.60%), and partially or completely recovered, with a neurological deficit 66 (27.00%), more in women (59.00%). In the atrial fibrillation treatment (67.00%), as the most frequent risk factor, a small part of the patients were on Warfarin and NOAC, 88 (52.30%) versus 134 on acetylsalicylic acid (80.20%). Research has shown that there is a statistically significant difference in the type and number of stroke risk factors in relation to age and sex of respondents. It has been found that elderly patients with greater comorbidity are more likely to be more mortally affected. It was also found that the male gender risk factor in the investigated population and that in the male population the total mortality was higher. Conclusion: Recognizing and systematically implementing a general policy of improving and preserving health as well as activities in the area of primary, specialist and hospital health care are the basic preconditions for achieving success in the prevention of cerebrovascular diseases. In creating such an environment, it is necessary to co-operate with other sectors of public life.