急性缺血性脑卒中患者院前延迟影响因素的Meta分析

Meta-analysis of influential factors of pre-hospital delay of patients with acute ischemic stroke

目的探讨急性缺血性脑卒中患者院前延迟的影响因素,为预防决策提供依据。方法以"缺血性脑卒中"、"院前延迟"、"就诊延迟"、"stroke"、"prehospital delay"、"pre-hospital delay"为检索词,收集2004年至2015年关于急性缺血性脑卒中院前延迟影响因素的文献,按照纳入与剔除标准选择文献,评价质量,提取数据,采用RevMan软件进行Meta分析。结果共纳入文献16篇,累计延迟组2966例,非延迟组2468例。影响急性缺血性脑卒中院前延迟多因素的OR及95%CI分别为:卒中重视度0.5(0.30,0.82)、急救医疗服务(emergency medical service,EMS)0.49(0.29,0.85)、国立卫生研究院卒中量表(National Institute of Health Stroke scale,NHISS)评分0.58(0.36,0.95)、首诊门诊4.28(1.44,12.74)、距离0.76(0.61,0.95)、缺血性脑卒中病史0.37(0.18,0.79),均P<0.05,差异具有统计学意义。结论急性缺血性脑卒中患者院前延迟保护因素为卒中重视度高、采用EMS、NHISS评分高、距离近、有缺血性脑卒中病史;危险因素为首诊门诊。这提示我们应加强脑卒中患者急救意识,加强患者及家属相关知识教育,增加急救系统使用率,建立完善、高效的缺血性脑卒中的绿色通道,缩短急性缺血性脑卒中患者延迟就诊。

Objective To investigate the main risk factors influencing the pre -hospital delay of patients with acute ischemic stroke （AIS） for preventing methods. Methods A retrieval was done across the epidemiologic studies on pre -hospital delay of AIS patients during 2004 to 2015 using the key words of ischemic stroke,prehospital delay,treatment delay. According to the inclusion and exclusion criteria,the literature was collected and the literature quality was assessed. The data were extracted for meta -analysis by RevMan software. Results Sixteen epidemiologic studies were included. Totally,there were 2 ,966 cases of prehospital delay and 2,468 cases of non-delay. The pooled OR values and 95% Cl by multivariate analysis were as follows： the degree of awareness of stroke was 0.5（0.3,0.82）,emergency medical service（EMS） was 0.49 （0.29,0.85）,National Institute of Health Stroke scale（NHISS） score 0.58 （0.36, 0.95）,outpatient visit as first visit 4.28 （1.44, 12.74）, distance 0.76 （0.61, 0.95）, medical history of ischemic stroke 0.37 （0.18,0.79） （with significant differences in OR value,%〈0.05）. Conclusions The protective factors for pre-hospital delay of acute ischemic stroke patients include： strengthened awareness of stroke,effective EMS,high NHISS score,short distance,medical history of ischemic stroke. The main risk factor is that their outpatient visit is their first visit for medical treatment. Therefore,we need to enhance the health education to the patients and their families about awareness of stroke, improve the use of EMS and build complete and efficient green path for the stroke patient.