早期就诊的急性缺血性卒中病人未溶栓原因分析

An analysis of the reasons for exclusion from thrombolysis in patients with acute ischemic stroke

目的:研究6小时内到达医院就诊的急性缺血性脑卒中未进行溶栓治疗的原因。方法:通过对实施急性脑血管病急诊绿色通道1年期间,发病6小时内就诊的患者未进行溶栓治疗的原因进行分析。结果:166例缺血性脑卒中患者在发病6小时内经急诊绿色通道就诊,81例符合溶栓条件的患者中47例接受溶栓治疗,占符合溶栓条件患者28.31%。溶栓患者平均发病时间(211.70±86.10)min,NIHSS评分10(范围5～22)。静脉溶栓25例,动脉溶栓22例。从发病至静脉溶栓平均开始时间为(55.48±26.01)min,明显短于动脉溶栓平均开始时间(86.59±40.40)min(P=0.003)。119例未进行溶栓治疗患者中不符合条件85例,符合条件而未溶34例(占20.48%)。发病6小时内就诊的患者未溶栓的原因有神经功能障碍轻或明显改善、早期显示病灶、脑栓塞以及家属或患者拒绝。结论:发病6小时内就诊的患者未进行溶栓的可调整原因主要是家属或患者拒绝。加强公众对脑卒中的了解及接受程度有助于提高溶栓比例。

Objective： This study sought to determine why those eligible patients who arrive within 6 h after acute ischemic stroke did not receive thrombolysis. Methods： During the first year after implementing emergency medical service for stroke thromholysis, we prospectively evaluated all patients with acute ischemic stroke admitted to our center within 6h from onset. The reasons for exclusion from thrombolysis were analyzed. Results： Of 166 patients admitted by emergency medical service within 6h of symptoms onset, 81 patients were eligible for thrombolysis, 47 of them （representing 28. 31% of all patients） received thrombolysis with interval times from stroke to emergency department arrival of （211.70± 86.10）min and Median National Institutes of Health Stroke Scale （NIHSS） score of 10 points on admission （range 54 22）, a door to needle interval of IV thrombolysis （55.48±26.01min）was shorter than those of intra-arterial thrombolysis （86.59±40.40min, P=0.003）. One hundred and nineteen patients were excluded from thrombolytic medications, 85 patients were ineligible for the therapy including 34 of them（20.48 % ）were eligible for thrombolysis. The major reasons that accounted for therapy exclusions were too mild or improving deficit, CT indicated infarct and intracranial hemorrhage, refusing consent by patients or next of kin. Conclusions： The main modifiable reasons for not applying thrombolysis to patients who arrive early enough is refused consent by patients or next of kin. Minimizing the door-to needle time by improvements of intra-hospital coordination and increasing awareness about stroke would increase the number of patients who might receive thrombolysis.