北京市急性缺血性脑血管病患者院前延迟时间分布及影响因素分析

Beijing acute ischemic cerebrovascular patients with pre - hospital delay time distribution and influencing factors analysis

目的调查现阶段北京市急性脑卒中患者的院前延迟时间分布情况以及主要的影响因素。方法本文主要通过收集北京市现阶段急性脑卒中患者的就诊流程的资料，详细记录院前延迟时间段以及患者的一般信息，通过统计学方法试分析影响院前延迟的主要因素。结果自2005—10～2006—10，连续收集北京市15家三甲医院698例急性缺血性脑血管病患者，发病年龄31～89岁，平均56．72±12．96岁；院前延迟时间范围分布为0．83～19．17h，中位数为6．61h；其中，使用EMS（急救系统）的院前延迟中位时间为4．65h，未使用EMS的院前延迟中位时间为6．95h；3h内就诊率为16．4％，6h内就诊率为34．1％；多元逻辑回归分析出影响因素主要有3个，分别是发病时间、基层医院延迟以及发病后的疾病严重程度。结论使用EMS可以缩短院前延迟时间；应当加强公众脑血管病知识教育，并宣传EMS的作用，同时加强医院与急救系统的密切合作，说明建设急性脑卒中救治绿色通道的必要性。

Objective To investigate the time distribution and influencing factors of pre - hospital delay in the patients with acute ischemic stroke in Beijing at this stage. Methods This paper mainly through the collection at this stage of treatment in patients with acute stroke process information in Beijing, detailed recond of pre - hopital delay time, as well as patients with general information, through the analysis of statistical methods to test the impact of pre - hospital delay in the main factor. Results From 2005 -10 to 2006 -10, we evaluated the medical records of 689 consecutive stroke or transient ischemic attack patients admitted to 15 major hospitals in Beijing within 24 hours after symptom onset, 689 cases were enrolled. The pre - hospital delay was 6.61h （ median）. In the phase of pre - hospital delay, the patients who chose EMS as the delivery method had a shorter delay time than those who didnt; Only 16. 4% of them admitted within 3 hours, 34.1% were within 6 hours. Logistic Regression Analysis showed the following factors were influenced on prehospital delay： anset time, grass -roots hospitals delayed and the severity of incidence. Conclusion EMS could reduce the pre - hospial delay. The education system for the public and the further cooperation with EMS are the key to reduce the pre - hospital delay for the acute ischemic patients.