中国急性脑梗死院前延误影响因素分析

Factors Associated with Pre-hospital Delay in the Presentation of Acute Ischemic Stroke in China

目的分析我国急性脑梗死患者院前延误的影响因素。方法中国国家卒中登记数据库于200侔9月到2008年8月连续收集来自全国各地152家二级和三级医院的急性卒中住院患者。本研究利用该数据库中的患者信息，以发病至到院时间大于3h为院前延误，通过单因素和多因素Logistic回归分析，探讨急性缺血性卒中患者院前延误的影响因素。结果本研究对来自中国国家卒中登记数据库的10505例急性脑梗死患者进行院前延误影响因素的分析，结果发现仅有21．58％的患者（n=2267）在发病5h内到达医院。导致院前延误时间缩短的因素有：老龄[调整后的比值比（odds ratio，OR）0．992，95％可信区间（confidencei nterval，CI）0．988～0．9971、使用急救车到达医院（调整后的OR 0．540，95％C／0．500～0．584）、饮酒史（调整后的DR0．895，95％C／0．802～0．999）、冠状动脉粥样硬化性心脏病史（调整后的OR0．786，95％C／0．684～0．905）、心房颤动病史（调整后的OR0．555，95％引0．452．～0．635）、首发症状为意识障碍（调整后的OR0．660，95％010．561～0．776）。导致院前延误时间延长的因素：单独居住（调整后的OR1．760，95％纠1．507～2．571）、自费医疗（调整后的OR1．255，95％C/1．081～1．411）、睡醒时发现症状（调整后的OR1．678，95％C/1．489～1．891）、发病前改良Rankin量表（modified Rankin Scale，mRS）评分≥2分（调整后的OR1．445，95％C／1．207-1．750）、高血压病史（调整后的OR1．114，95％C/1．004-1．2-38）、糖尿病病史（调整后的0R 1．141，95％C/1.006～1．295）、首发症状为失语（调整后的DR1．580，95％C／1．259～1．556）、首发症状为视野缺损（调整后的OR1．458，95％d1．056～2．051）。结论我国脑梗死患者的院前延误现象比较严重，提高公众对卒中的认识，加强院前急救系统的使用，早期发现症状，尽可能使用救护系统，缩短院前延误时间，使患者得到及时有效的诊治。

Objective To explore the factors associated with pre-hospital delay of acute ischemic stroke. Methods Data from the China National Stroke Registry （CNSR） were used to identify patients who were consecutively admitted to 132 urban hospitals across China with acute stroke between September 2007 and August 2008. According to three hours as cut-off point of the onset-door time factors associated with delayed presentation to hospital were evaluated. Univariate and multivariate analyses were performed to analyze relationships between patient characteristics and delayed presentation,Results Of 10 503 acute ischemic stroke （21.58%） arrived into the hospital within patients entered into the CNSR, only 2267 patients 3 hours. There are some factors that could shorten presentation to hospital such as the aged, transferred by ambulance, history of drinking, coronary heart disease, atrial fibrillation, and first symptom of unconsciousness. Factors associated with prehospital delay are as follows： living alone, self-payment for medical insurance, finding the symptom awake, modified Rankin Scale （mRS） score of pre-stroke more than 2, history of hypertension, diabetes, first symptom of aphasia and defect of field vision. Conclusion The phenomenon of pre-hospital delay of acute ischemic stroke in China is still serious. We should impart enough knowledge of stroke to people and encourage them to use the emergency system, in order to increase the awareness rate and improve treatment and prognosis.