急诊预检分诊护士对脑卒中患者的识别现状及影响因素分析

doi:10.3761/j.issn.2096-7446.2026.10.005

摘要/Abstract

摘要：

目的调查急诊预检分诊护士识别脑卒中患者的现状及影响因素，为进一步优化脑卒中预检分诊流程提供参考。方法对2024年9月—12月镇江市某三级甲等医院急诊预检分诊脑卒中患者391例的临床资料进行回顾性分析。采用Logistic回归分析方法筛选影响分诊护士正确识别的影响因素。结果根据分诊护士是否正确识别脑卒中患者分为正确识别组197例与未正确识别组194例。急诊预检分诊护士对脑卒中患者正确识别率为50.3%。两组一侧肢体无力或麻木、一侧面部麻木或口角歪斜、言语不清、头晕或眩晕、恶心呕吐、意识障碍、头痛、既往糖尿病史、既往房颤病史、指脉搏血氧饱和度、当班分诊护士是否为急诊急救专科护士比较，差异有统计学意义（P<0.05）。进一步Logistic回归分析显示，一侧肢体无力或麻木（OR=0.498）、头晕或眩晕（OR=5.702）、意识障碍（OR=3.927）、既往房颤病史（OR=0.332）及分诊护士为急诊急救专科护士（OR=0.336），是急诊预检分诊护士对脑卒中患者正确识别的独立影响因素（P<0.05）。结论急诊预检分诊护士对脑卒中典型症状正确识别率较高，对非典型症状正确识别率较低。建议加强房颤病史、头晕等高危人群的问诊体检，并配备急诊急救专科护士；建立适合各级医院的脑卒中急诊预检分诊管理机制，推动脑卒中预检分诊流程标准化管理。

关键词: 急诊, 预检分诊, 脑卒中, 影响因素, 急救护理

Abstract:

Objective To investigate the current situation of emergency triage nurses’ correct identification of stroke patients and the risk factors，so as to provide a reference for further optimizing the emergency triage and screening process for stroke patients. Methods A retrospective analysis was conducted on the clinical data of 391 stroke patients in the emergency triage of a tertiary hospital in Zhenjiang from September to December 2024. Logistic regression analysis was used to screen the influencing factors of correct identification by triage nurses. Results The patients were divided into a correct identification group（197 cases） and an incorrect identification group（194 cases） based on whether the triage nurses correctly identified the stroke patients. The correct identification rate of stroke patients by emergency triage nurses was 50.3%. There were statistically significant differences between the two groups in terms of unilateral limb weakness or numbness，unilateral facial numbness or deviation of the mouth corner，unclear speech，dizziness or vertigo，nausea and vomiting，consciousness disorder，headache，history of diabetes，history of atrial fibrillation，finger pulse oxygen saturation，and whether the on-duty triage nurse was a specialized emergency nurse（P<0.05）. Further logistic regression analysis showed that unilateral limb weakness or numbness（OR=0.498），dizziness or vertigo（OR=5.702），consciousness disorder（OR=3.927），history of atrial fibrillation（OR=0.332），and the triage nurse being a specialized emergency nurse（OR=0.336） were independent influencing factors for the correct identification of stroke patients by the emergency triage nurse（P<0.05）. Conclusion Emergency triage nurses have a relatively high correct recognition rate for typical symptoms of stroke，but a relatively low correct recognition rate for atypical symptoms. It is suggested to conduct more in-depth inquiries and physical examinations for high-risk groups such as those with atrial fibrillation or dizziness，and to equip emergency rescue specialist nurses，to establish a management mechanism for emergency triage of stroke in hospitals at all levels，and promote the standardization of triage process for stroke.

Key words: Emergency, Triage and Screening, Stroke, Influencing Factors, Emergency Nursing

张仁敏, 王明明, 王鹏, 汤舒婷, 陈燕, 凌亚菁. 急诊预检分诊护士对脑卒中患者的识别现状及影响因素分析[J]. 中华急危重症护理杂志, 2026, 7(10): 1187-1193.

ZHANG Renmin, WANG Mingming, WANG Peng, TANG Shuting, CHEN Yan, LING Yajing. Analysis of the current situation and influencing factors of emergency triage nurses’ identification of stroke patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(10): 1187-1193.

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参考文献 26

[1]	GBD 2019 Stroke Collaborators. Global,regional,and national burden of stroke and its risk factors,1990-2019:a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol,2021, 20(10):795-820. doi: 10.1016/S1474-4422(21)00252-0
[2]	张萌, 马咏馨, 贾琼, 等. 静脉溶栓治疗急性轻型非致残性缺血性脑卒中有效性和安全性的临床观察:一项单中心回顾性观察研究[J]. 首都医科大学学报, 2025, 46(1):56-62.
	Zhang M, Ma YX, Jia Q, et al. Clinical observation on the efficacy and safety of intravenous thrombolysis in the treatment of acute mild non-disabling ischemic stroke:a single-center retrospective observational study[J]. J Cap Med Univ, 2025, 46(1):56-62.
[3]	Gude MF, Valentin JB, Christensen HC, et al. Associations between emergency call stroke triage and pre-hospital delay,primary hospital admission,and acute reperfusion treatment among early comers with acute ischemic stroke[J]. Intern Emerg Med, 2023, 18(8):2355-2365. doi: 10.1007/s11739-023-03349-x
[4]	中华护理学会急诊护理专业委员会, 浙江省急诊医学质量控制中心. 急诊预检分诊标准(成人部分)[J]. 中华急危重症护理杂志, 2020, 1(1):45-48.
	Emergency Nursing Committee of Chinese Nursing Association,Emergency Medical Quality Control Center of Zhejiang Province. Emergency triage scale(adult part)[J]. Chin J Emerg Crit Care Nurs, 2020, 1(1):45-48.
[5]	Liang X, Gao WH, Xu JL, et al. Triage nurse-activated emergency evaluation reduced door-to-needle time in acute ischemic stroke patients treated with intravenous thrombolysis[J]. Evid Based Complement Alternat Med, 2022, 2022:9199856.
[6]	杨叶平. 基于急诊检伤与急迫度分级量表标准下急诊分诊系统在急腹症患者中的应用[J]. 临床护理杂志, 2020, 19(3):42-44.
	Yang YP. Application of emergency triage system in patients with acute abdomen based on emergency injury detection and urgency rating scale[J]. J Clin Nurs, 2020, 19(3):42-44. doi: 10.1111/jcn.2009.19.issue-1-2
[7]	国家卫生健康委员会. 脑血管病防治指南(2024年版)[J]. 磁共振成像, 2025, 16(1):1-8.
	National Health Commission. Guideline for prevention and treatment of cerebrovascular disease(2024 edition)[J]. Chin J Magn Reson Imag, 2025, 16(1):1-8.
[8]	高永祥, 张晋昕. Logistic回归分析的样本量确定[J]. 循证医学, 2018, 18(2):122-124.
	Gao YX, Zhang JX. Determination of sample size in logistic regression analysis[J]. J Evid Based Med, 2018, 18(2):122-124.
[9]	刘亚杰, 冯亚聪, 白晶, 等. 急性非创伤性胸痛患者急诊分诊情况的调查分析[J]. 临床医学, 2025, 45(2):38-40.
	Liu YJ, Feng YC, Bai J, et al. Investigation and analysis of emergency triage of patients with acute non-traumatic chest pain[J]. Clin Med, 2025, 45(2):38-40.
[10]	Choi Y, Lee H. Factors related to under-triage of patients with acute coronary syndrome in the emergency department:a retrospective study[J]. Int Emerg Nurs, 2023, 69:101316. doi: 10.1016/j.ienj.2023.101316
[11]	金璇. 影响急诊预检分诊准确率的因素分析与管理对策[J]. 中医药管理杂志, 2021, 29(16):234-235.
	Jin X. Analysis of factors affecting the accuracy of emergency pre-examination and triage and management countermeasures[J]. J Tradit Chin Med Manag, 2021, 29(16):234-235.
[12]	Hoyer C, Szabo K. Pitfalls in the diagnosis of posterior circulation stroke in the emergency setting[J]. Front Neurol, 2021, 12:682827. doi: 10.3389/fneur.2021.682827
[13]	杨颖, 韩春玉, 段永伟. 老年脑干梗死患者的临床特点研究[J]. 中国现代医生, 2023, 61(33):45-48.
	Yang Y, Han CY, Duan YW. The study of clinical characteristics of the elderly patients with brainstem infarction[J]. China Mod Dr, 2023, 61(33):45-48.
[14]	王瑶, 方熙, 李华, 等. 脑卒中患者在急诊卒中绿色通道中常见症状及早期筛查的临床价值分析[J]. 中国急救医学, 2022, 42(12):1055-1060.
	Wang Y, Fang X, Li H, et al. The clinical value of common symptoms and early mass screening of stroke patients in the emergency stroke green-way[J]. Chin J Crit Care Med, 2022, 42(12):1055-1060.
[15]	周思雨, 贺惠娟, 张媛, 等. 急性脑卒中患者症状群及桥梁症状分析[J]. 实用心脑肺血管病杂志, 2024, 32(11):98-103,114.
	Zhou SY, He HJ, Zhang Y, et al. Symptom clusters and bridge symptoms in patients with acute stroke[J]. Pract J Card Cereb Pneumal Vasc Dis, 2024, 32(11):98-103,114.
[16]	周丽萍, 叶欢, 娄洁香, 等. 急性脑卒中筛查量表的研究进展[J]. 中华急危重症护理杂志, 2023, 4(7):664-669.
	Zhou LP, Ye H, Lou JX, et al. Research progress of acute stroke screening scale[J]. Chin J Emerg Crit Care Nurs, 2023, 4(7):664-669.
[17]	Lever NM, Nyström KV, Schindler JL, et al. Missed opportunities for recognition of ischemic stroke in the emergency department[J]. J Emerg Nurs, 2013, 39(5):434-439. doi: 10.1016/j.jen.2012.02.011 pmid: 22633790
[18]	Sanalp Menekşe T, Şirin i, Otal Y. Diagnostic performance of a novel clinical score for predicting acute ischemic stroke in emergency department patients presenting with vertigo or dizziness[J]. BMC Emerg Med, 2025, 25(1):127. doi: 10.1186/s12873-025-01284-y pmid: 40660131
[19]	Kim T, Jeong HY, Suh GJ. Clinical differences between stroke and stroke mimics in code stroke patients[J]. J Korean Med Sci, 2022, 37(7):e54. doi: 10.3346/jkms.2022.37.e54 pmid: 35191231
[20]	Tan S, Tang C, Ng JS, et al. Delays in the diagnosis of ischaemic stroke presenting with persistent reduced level of consciousness:a systematic review[J]. J Clin Neurosci, 2023, 115:14-19. doi: 10.1016/j.jocn.2023.07.009
[21]	Nishiwaki T, Enomoto Y, Egashira Y, et al. Timeliness and accuracy of the 7-Item Japan Urgent Stroke Triage(JUST-7) score,a prehospital stroke triage tool,assessed by emergency medical services[J]. PLoS One, 2024, 19(8):e0309326. doi: 10.1371/journal.pone.0309326
[22]	中国医疗保健国际交流促进会急诊医学分会, 中华医学会急诊医学分会, 国家老年医学中心, 等. 急性心房颤动中国急诊管理指南(2024)[J]. 中国急救医学, 2024, 44(8):645-667.
	Emergency Medicine Branch of Chinese Medical Care International Exchange Promotion Association,Emergency Medical Branch of Chinese Medical Association, National Center of Gerontology, et al. Emergency management guidelines for acute atrial fibrillation in China(2024)[J]. Chin J Crit Care Med, 2024, 44(8):645-667.
[23]	中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会, 黄从新, 等. 中国心房颤动管理指南(2025)[J]. 中国心脏起搏与心电生理杂志, 2025, 39(4):273-343.
	Chinese Society of Pacing and Electrophysiology,Chinese Society of Arrhythmias, Huang CX, et al. Chinese guidelines for the management of atrial fibrillation(2025)[J]. Chin J Card Pacing Electrophysiol, 2025, 39(4):273-343.
[24]	Kim JS, Bae HJ, Kim M, et al. Stroke prediction in patients presenting with isolated dizziness in the emergency department[J]. Sci Rep, 2021, 11(1):6114. doi: 10.1038/s41598-021-85725-1
[25]	古瑞平, 蓝立欢, 何蕴丝, 等. 专职护士救护流程在急性缺血性脑卒中患者中的应用效果[J]. 中国急救复苏与灾害医学杂志, 2025, 20(8):1098-1102.
	Gu RP, Lan LH, He YS, et al. Application effect of full-time nurse rescue process on patients with acute ischemic stroke[J]. China J Emerg Resusc Disaster Med, 2025, 20(8):1098-1102.
[26]	翁艳秋, 陆小英, 李冬梅, 等. 脑卒中急救护士分层培养与使用[J]. 中华护理教育, 2021, 18(4):303-306.
	Weng YQ, Lu XY, Li DM, et al. The stratified cultivation and employment of stroke emergency nurses[J]. Chin J Nurs Educ, 2021, 18(4):303-306.