急性缺血性脑卒中患者发病至急诊科时间间隔的影响因素研究

Influencing Factors for the Time Interval Between Onset to Arrival at Emergency Department for Patients With Acute Cerebral Arterial Thrombosis

目的探讨急性缺血性脑卒中患者发病至急诊科时间间隔的影响因素。方法选取2010年1月—2013年10月绍兴市人民医院急诊科收治的急性缺血性脑卒中患者1 081例为研究对象,根据发病到送至急诊科的时间间隔将患者分为早送至急诊科(≤3 h)组和晚送至急诊科(>3 h)组。比较两组年龄、性别、并发症、发病地点、送至急诊科时美国国立卫生研究院脑卒中量表(NIHSS)评分、送至急诊科途径;采用多因素Logistic回归分析对患者发病到送至急诊科的时间间隔进行分析。结果 88例(8.1%)接受溶栓治疗,均属于早送至急诊科组患者。早送至急诊科组患者与晚送至急诊科组患者的糖尿病发生率,心房颤动发生率、充血性心力衰竭发生率、送至急诊科途径、送至急诊科时NIHSS评分,手臂、腿部和脸部无力发生率,手臂、腿部和脸部麻木发生率,头晕发生率、视觉异常发生率、精神状态改变发生率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,糖尿病、心房颤动、送至急诊科途径、送至急诊科时NIHSS评分、精神状态改变是患者发病到送至急诊科的时间间隔的独立影响因素(P<0.05)。结论采用急诊120不仅可以帮助急性缺血性脑卒中患者尽早送至急诊科,而且还可有效地促进溶栓治疗,缩短了发病到治疗的时间,值得临床参考。

Objective To investigate the influencing factors for the time interval between onset to arrival at emergency department for patients with acute cerebral arterial thrombosis. Methods The study enrolled 1 081 subjects with acute cerebral arterial thrombosis who were admitted into Department of Emergency,Shaoxing People＇ s Hospital from January 2010 to October2013. According to the time interval between onset to arrival at emergency department, these patients were divided into two groups： early arrival group（ ≤3 h） and late arrival group（ 3 h）. Comparison was made between the two groups in age,gender,complications,onset place,NIHSS score at arrival,approach to emergency department. Multivariate Logistic regression analysis was made on the time interval between onset and arrival. Results There were 88（ 8. 1%） patients who received thrombolytic therapy and all had early arrival at emergency department. The two groups were significantly different in the incidence rates of diabetes,atrial fibrillation and congestive heart failure,approach to emergency department,NIHSS score at arrival,the incidence of atony in the arms,legs and face,the incidence of numbness in the arms,legs and face,and the incidence rates of dizziness,abnormal vision and change of psychological state（ P〈0. 05）. Multivariate Logistic regression analysis showed that diabetes,atrial fibrillation,approach to emergency department,NIHSS score at arrival and change of psychological state were independent influencing factors for the time interval between onset to arrival at emergency department（ P〈0. 05）. Conclusion Emergency treatment following 120 calls can help patients with acute cerebral arterial thrombosis arrive at emergency department earlier,effectively promote thrombolytic therapy,and reduce the time interval from onset to treatment,which is worth clinical reference.