急性缺血性脑卒中静脉溶栓治疗院前延误的相关因素分析

Analysis of related factors of pre-hospital delay in intravenous thrombolytic therapy for acute ischemic stroke

目的分析急性缺血性脑卒中静脉溶栓治疗院前延误的影响因素。方法通过统一的问卷对甘肃省兰州市某三甲医院2017年1月1日~2018年6月30日收治的267例急性缺血性脑卒中(AIS)患者进行调查。根据是否在发病2 h内送到医院,将患者设置为延误组和非延误组,对影响脑卒中治疗的院前因素进行相关因素分析。结果(1)两组患者的基线资料中教育程度、医保类型差异有统计学意义(P<0.05);(2)两组患者临床特征中意识障碍及预后比较,差异具有统计学意义(P<0.05);(3)影响脑卒中患者延误的多因素分析显示:来院途径、患者受教育程度、NIHSS(National Institute of Health stroke scale)评分、脑卒中病史是影响患者2 h到达医院的独立因素。结论通过急救系统与患者受教育程度可有效缩短DNT(Door-to-needle time)时间,对广大群众进行脑卒中知识的普及,可使更多的AIS患者得到有效治疗。

Objective To analyze the influencing factors of pre-hospital delay in intravenous thrombolytic therapy for acute ischemic stroke. Methods A total of 267 patients with acute ischemic stroke who were diagnosed from January 1, 2017 to June 30, 2018, a top three hospital in Lanzhou, Gansu Province, were investigated through a unified questionnaire. According to whether they were sent to the hospital within 2 hours after the onset of the disease, the patients were set as the delay group and the non-delay group, and relevant factors were analyzed for the pre-hospital factors affecting the stroke treatment. Results (1)There were statistical differences in the educational level and type of medical insurance in the baseline data of the two groups(P<0.05).(2)The differences in consciousness and prognosis in the clinical features of the two groups were statistically significant(P<0.05).(3)Multivariate analysis affecting the delays of stroke patients showed that how to reach the hospital, the degree of education of the patient, NIHSS(National Institute of Health stroke scale) score, history of stroke, were independent factors that affected patients' arrival at the hospital for 2 hours. Conclusion DNT(Door-to-needle time) time can be effectively shortened by first aid system and patient education, and the popularization of stroke knowledge among the masses can enable more patients with AIS to receive effective treatment.