院前预通知对急性缺血性卒中患者静脉溶栓治疗院内延误的影响

Relationship between pre-notification and the in-hospital delay of intravenous thrombolysis for acute ischemic stroke

目的探讨急救系统应用移动电话预通知措施对缺血性卒中急性期静脉溶栓治疗院内时间延误的影响。方法回顾性连续纳入2015年8月至12月首都医科大学宣武医院接受静脉溶栓治疗的缺血性卒中患者96例,依据有无采用院前预通知措施分为有预通知组(18例)和无预通知组(78例)。以入院至治疗中位数时间及入院至治疗时间≤60 min(入院至治疗时间达标率)的比例为主要终点指标;以入院至评估时间、入院至获得影像结果时间、入院至获得实验室结果时间、静脉溶栓决策时间、发病至治疗中位数时间以及发病至治疗时间≤180 min的比例为次要指标。比较两组各变量及时段的差异。结果有预通知组冠心病发生率、基线NIHSS评分水平、溶栓前紧急降压治疗比例明显高于无预通知组,组间差异均有统计学意义[33.3%(6/18)比10.3%(8/78),9(4,17)分比4(3,9)分,27.8%(5/18)比7.7%(6/78),均P<0.05];其余基线资料的组间差异均无统计学意义(均P>0.05)。有预通知组入院至治疗时间、发病至治疗时间、入院至评估时间明显低于无预通知组,入院至治疗时间达标(入院至治疗时间≤60 min)比例高于无预通知组,组间差异均有统计学意义[45(33,49)min比51(40,60)min,134(110,165)min比167(127,215)min,1(1,4)min比8(4,12)min,100%(18/18)比75.6%(59/78),均P<0.05];两组发病至入院时间、入院至影像结果获得时间、入院至实验室结果获得时间、静脉溶栓决策时间及发病至治疗时间≤180 min比例的差异均无统计学意义(均P>0.05)。结论急救系统的院前预通知方案可以缩短急性缺血性卒中静脉溶栓院内时间延误,提高入院至治疗时间达标(≤60 min)率。

Objective To investigate the relationship between pre-notification used in emergency medical service and the in-hospital delay of intravenous thrombolysis （IVT） for acute ischemic stroke （AIS）. Methods A total of consecutive AIS patients （96 cases） treated with IVT between August 2015 and December 2015 were recruited in the pilot analysis. All enrolled patients were divided into the pre-notification group（18 cases） and non prc-notification group （78 cases）by with or without prc-notificatiorr The median door-to-needle time （DTN） and the rate of DTN ≤60 rain were set as primary endpoints. Secondary endpoint indicators included door-to-examination time （ DTE）, door-to-imaging time （ DTI ）, door-to-laboratory time（DTL） ,decision-making time,and onset-w-needle time （OTN）. Results The pre-notification group in the rate of coronary heart disease, baseline the National Institutes of Health Stroke Scale （NIHSS） score and the rate of urgent depressor therapy before IVT were higher than the non pre-notification group, the difference between the two groups were statistically significant （33.3% [6/18]vs. 10. 3% [8/78] ,914,17]vs. 4[3,9 ] score,27.8 % [ 5/18 ] vs. 7.7 % [ 6/78 ], all P 〈 0. 05 ） ; there were no significant difference in the other baseline data between the two groups. As for the primary endpoints, the median DTN was much lower （45 [33,49]vs. 51140,60]min） ,and the rate of DTN ≤60 min was higher （ 100% [ 18/18 ]vs. 75. 6% [59/ 78 ] ） in the pre-notification group than those of non pre-notification group. DTE was also significantly lower in the pre-notification group than that of non pre-notification group （ [ 11,4 ] vs. 8 [ 4,12 ] min, all P 〈 0. 05）. Conclusion Our study showed that pre-notification used in emergency medical service was associated with a reduction of DTN and a significant increase in the rate of DTN ≤60 min.