老年急性缺血性卒中患者院前延误的相关因素和趋势

Associated factors and trends for prehospital delay in elderly patients with acute ischemic stroke

目的探讨老年急性缺血性卒中（acute ischemic stroke, AIS）患者院前延误的相关因素及趋势。方法回顾性纳入2007年至2017年曲靖市第一人民医院收治的老年AIS患者，从医疗记录中收集患者资料，发病至到院时间〉2 h定义为就诊延误。对就诊延误组与非延误组人口统计学和基线资料进行比较，采用多变量logistic回归分析确定院前延误的相关因素。此外，还对研究期间不同阶段院前延误时间的趋势进行了分析。结果共纳入年龄≥65岁的老年AIS患者1 566例，平均年龄（75.61±6.06）岁，院前延误平均时间为（10.83±7.47）h，中位时间8.27 h。多变量logistic回归分析显示，高龄[优势比（odds ratio, OR）1.271，95%可信区间（confidence interval, CI）1.029~2.896；P=0.039]、夜间发病（OR 1.413，95% CI 1.067~3.859；P=0.013）和非典型症状发作（OR 2.345，95% CI 1.184~8.126；P=0.029）与院前延误呈独立正相关，而急诊医疗服务转运（OR 0.743，95% CI 0.261~0.998；P=0.010）、有医疗保险（OR 0.219，95% CI 0.015~0.799；P=0.042）以及发作时有旁观者（OR 0.618，95% CI 0.149~0.814；P=0.003）与院前延误呈独立负相关。2007年1月至2010年10月、2010年11月至2015年4月、2015年5月至2017年12月期间的院前延误平均时间分别为（12.59±7.06）h、（10.57±7.78）h和（8.47±7.07）h，呈下降趋势，但差异无统计学意义。结论高龄、夜间发病和非典型症状发作是院前延迟的独立危险因素，而急诊医疗服务转运、有医疗保险以及发作时存在旁观者为院前延误的独立保护因素。老年AIS患者的院前延误时间呈逐年下降趋势，但改善不显著，寻求及时医疗干预的延迟依然是重要的公共卫生问题。

ObjectiveTo investigate the associated factors and trends of prehospital delay in elderly patients with acute ischemic stroke （AIS）.Methods Elderly patients with AIS admitted to the First People＇s Hospital of Qujing from 2007 to 2017 were enrolled retrospectively. The data of patients was collected from the medical records. Onset-to-door time 〉2 h was defined as prehospital delay. The demographic and baseline data were compared between the delay group and the non-delay group. Multivariate logistic regression analysis was used to determine the associated factors for prehospital delay. In addition, the trends of prehospital delay time at the different stages of the study were also analyzed.Results A total of 1 566 patients with AIS aged ≥65 years were enrolled. Their mean age was 75.61±6.06 years. The mean time of prehospital delay was 10.83±7.47 h （median time 8.27 h）. Multivariate logistic regression analysis showed that advanced age （odds ratio [OR] 1.271, 95% confidence interval [CI] 1.029-2.896; P=0.039）, nocturnal onset （OR 1.413, 95% CI 1.067-3.859; P=0.013）, and atypical symptom onset （OR 2.345, 95% CI 1.184-8.126; P=0.029） were independently positively correlated with prehospital delay, while the emergency medical service transport （OR 0.743, 95% CI 0.261-0.998; P=0.010）, having medical insurance （OR 0.219, 95% CI 0.015-0.799; P=0.042）, and having a bystander at the time of onset （OR 0.618, 95% CI 0.149-0.814; P=0.003） were independently negatively correlated with prehospital delay. At the different stages of the study, January 2007 to October 2010, November 2010 to April 2015, and May 2015 to December 2017, the mean time of prehospital delay was 12.59±7.06 h, 10.57±7.78 h, and 8.47±7.07 h, respectively. They showed a decrease trend, but the difference was not statistically significant.ConclusionAdvanced age, nocturnal onset, and atypical symptom onset were the independent risk factors for prehospital delay, while emergency medical service transport, having medical insurance, and having a bystander at the time of onset were the independent protective factors for prehospital delay. The delay time of the elderly patients with AIS is declining year by year, but the improvement is not significant. The delay in seeking timely medical intervention remains an important public health problem.