云浮市区急性缺血性卒中超早期溶栓治疗影响因素和对策

Influential Factors and Strategies of Super-early Thrombolytic Therapy in Acute Ischemic Stroke in Yunfu City

目的:探讨云浮市区急性缺血性卒中患者超早期溶栓治疗院前、院内延误的影响因素。方法:以2015年01月至2016年12月我院收治的418例急性缺血性卒中患者基本资料为依据,以症状发生后3 h内是否入院治疗为标准,将其分为及时治疗组和延误治疗组,进行对比分析。结果:共304例符合研究要求,其中及时治疗组109例(35.9%),延误治疗组195例(64.1%);两组患者性别、年龄无明显差异(P>0.05),及时治疗组在对美国国立卫生研究院卒中量表(NIHSS)评分、对脑卒中的认识、溶栓治疗的知晓、发病时有旁观者,就医转运方式的比例均显著高于延误治疗组(P<0.01)。患者到院后,超早期接受rt-PA溶栓78例,平均到院至溶栓时间(DNT)109 min(最短47 min),存在有呼叫会诊、接受CT检查、检验报告发出等流程方面的延误。结论:目前急性缺血性卒中的治疗存在明显延误的情况,应结合延误原因,进行针对性强化。

Objective：To investigate the influencing factors of hospital forearm and hospital delay in patients with acute ischemic stroke in Yunfu city. Methods：From Jan 2015 to Dec 2016,418 patients with acute ischemic stroke were treated with the basic data. Whether they were admitted to hospital for treatment within 3 hours after the onset of symptoms were classified as timely treatment group and delayed treatment group,and the basic data were compared between the two groups. Results：A total 304 cases were researched. There were 109（35.9%）cases in the treatment group,while 195（64.1%）cases in the delayed treatment group. There was no significant difference in sex and age between the two groups（P0.05）. In the timely treatment group,the NIHSS score,the knowledge of treatment of thrombolytic therapy,at the onset of a spectator and transshipment mode of medical treatment were significantly higher than those in the delayed treatment group,all P 0.001. Patients in the hospital after the ultra-early to receive rt-PA thrombolysis in78 cases,the average DNT109 min（the shortest 47 min）,there was a call consultation,to accept CT examination,test report issued and other process delays. Conclusion：There is a significant delay in the treatment of acute ischemic stroke. It should be combined with the cause of delay and targeted enhancement.