院前急救对急性缺血性卒中患者溶栓时间的作用与影响因素分析

Effect of prehospital emergency system on duration of thrombolysis in patients with acute ischemic stroke and its influencing factors

目的探讨院前急救系统在针对急性缺血性卒中患者溶栓时间中发挥的效用,并分析救护车来院的影响因素。方法回顾性分析急诊收治的卒中溶栓患者,依据患者来院方式分为120来院组(86例)和自行来院组(138例)。比较2组基本情况(性别、年龄、婚姻状态、医保支付情况)和既往存在卒中的危险因素情况(高血压、糖尿病、冠心病、血脂异常、心脏瓣膜疾病、心房颤动、卒中病史)、发病时症状(肢体乏力/无力、口齿不清、视觉障碍、凝视、头晕头痛、意识障碍)、到院时血压、心率、血糖、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NHISS)评分、主要结果[患者发病到接受溶栓治疗的时间(onset to needle time,ONT)];次要结果[从发病到急诊门口时间(onset to door time,ODT)、从发病到接受CT检查时间(onset to CT time,OCT)、从急诊大门到接受CT检查时间(door to CT time,DCT)、从急诊大门到接受溶栓治疗时间(door to needle time,DNT)],分析采用救护车到院的影响因素。结果2组心房颤动病史、肢体乏力/无力、口齿不清、视觉障碍、凝视、意识障碍、同时出现多个症状(≥4个症状)、ODT、OCT、ONT、溶栓前NHISS评分差异有统计学意义(P<0.05);2组性别、年龄、户籍、婚姻状态、是否使用医保、高血压、糖尿病、高血脂症、冠心病、心脏瓣膜疾病、卒中病史、吸烟史、喝酒史、头晕头痛症状、收缩压、舒张压、心率、血糖、DCT、DNT差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,心房颤动(95%CI:0.127~0.834,P<0.05)、肢体乏力/无力(95%CI:0.018~0.399,P<0.05)、口齿不清(95%CI:0.117~0.924,P<0.05)是缺血性卒中患者选择救护车来院的保护因素。结论选择救护车到院卒中患者,可以明显缩短ONT,对于有卒中风险的患者,要加强日常慢性病管理和健康教育,并进一步理清思路、针对现有的卒中救治网络流程做优化。

Objective To explore the efficacy of prehospital emergency system in duration of thrombolysis for patients with acute ischemic stroke(AIS),and to analyze the influencing factors of arrival by ambulance.Methods A retrospective analysis was made on the stroke patients undergoing thrombolytic therapy in Emergency Department.The patients were divided into arrival by ambulance group(n=86)and self-visiting group(n=138)according to their method of visiting the hospital.The basic information(gender,age,marital status,and medical insurance payments)and the risk factors for previous stroke[hypertension,diabetes,coronary heart disease(CHD),dyslipidemia,history of cardiac valvular disease,atrial fibrillation(AF),and stroke)],the symptoms at onset(limb weakness/weakness,slurred speech,visual disturbances,gaze,dizziness,headache,disturbance of consciousness),blood pressure at admission,heart rate,blood glucose,National Institute of Health Stroke Scale(NHISS)score,primary outcome[onset to needle time(ONT)],secondary outcomes[onset to door time(ODT),onset to CT time(OCT),door to CT time(DCT),door to needle time(DNT)]betweem two groups,and the influencing factors of arrival by ambulance were analyzed.Results There were significant differences in the two groups with respect to history of AF,limbweakness/weakness,slurred speech,visual disturbances,gaze,dizziness,presence of multiple symptoms(≥4 symptoms),ODT,OCT,ONT and NHISS scores before thrombolysis(P<0.05).There were no significant differences in the two groups with respect to gender,age,household register,marital status,use of medical insurance payments,hypertension,diabetes,hyperlipidemia,CHD,cardiac valvular disease,stroke history,smoking history,drinking history,dizziness and headache,systolic blood pressure,diastolic blood pressure,heart rate,blood glucose,DCT and DNT(P>0.05).Multivariate Logistic regression analysis showed AF(95%CI:0.127-0.834,P<0.05),limb weakness/weakness(95%CI:0.018-0.399,P<0.05),and slurred speech(95%CI:0.117-0.924,P<0.05)were protective factors for arrival by ambulance in patients with ischemic stroke.Conclusion Arrivial by ambulance for stroke patients can significantly shorten ONT.For patients at risk of stroke,daily chronic disease management and health education should be strengthened,and ideas should be further clarified to optimize the established stroke treatment network process.