河北省急救医疗服务在脑卒中救治中应用情况的现状分析

Analysis on the application of emergency medical service in acute stroke treatment in Hebei Province

目的调查河北省急救医疗服务(emergency medical service,EMS)在脑卒中救治过程中的使用情况及初步分析其在脑卒中救治中的价值。方法收集河北省49家医院在2016年1月至2016年12月经急诊入院的4147例脑卒中患者的救治资料。依就诊方式分为EMS组和非EMS组,比较两组患者的一般情况、症状发作到就诊时间、入院到治疗时间、溶栓率、住院天数、预后等指标。正态分布的计量资料采用LSD-t检验、非正态分布的连续变量采用Mann-Whitney U检验,计数资料组间比较采用χ2检验或Fisher精确概率法。结果纳入患者4147例,其中出血性脑卒中589例(14.2%),缺血性脑卒中3558例(85.8%)。共有750例(18.1%)患者使用EMS就诊。出血性脑卒中使用EMS就诊的比例高于缺血性脑卒中(33.4%vs 15.5%,P<0.01)。EMS组症状发作到就诊的中位时间低于非EMS组的中位时间(1.75 h vs 4.57 h,P<0.01)。在患者症状开始到就诊时间<1 h时段中采用EMS就诊中位时间高于非EMS组的中位时间(0.67 h vs 0.53 h,P<0.01)。在1~<2 h时段及2~<3 h时段两组差异无统计学意义。在≥3 h时段中采用EMS就诊中位时间短于非EMS组的中位时间(5.0 h vs 9.47 h,P<0.01)。EMS组症状开始到就诊时间<3 h的患者高于非EMS组(66.13%vs 57.44%,P<0.01)。EMS组入院到治疗的中位时间低于非EMS组(87 min vs 101 min,P<0.01)。EMS组溶栓率高于非EMS组(15.9%vs 11.0%,P=0.001)。EMS组住院天数低于非EMS组[11(7,14)d vs 12(6,16)d,P<0.01]。EMS组预后良好的比例优于非EMS组(88.8%vs 85.5%,P=0.02)。结论EMS在一定程度上可以缩短脑卒中患者症状发作到就诊时间,降低入院到治疗时间,提高溶栓率,减少住院天数,改善患者预后。

Objective To investigate the application of emergency medical service(EMS)of Hebei Province and preliminarily analyze its value in the treatment of acute stroke patients.Methods We collected data of 4147 acute stroke patients admitted to the Emergency Department between January 2016 and December 2016 in 49 hospitals of Hebei Province.Patients were divided into the EMS group and non-EMS group according to the pattern of arriving hospital.The general data,the onset-to-door time,door-to-treatment time,thrombolytic rate,length of hospital stay and prognosis were compared between the two groups.LSD-t test,Mann-Whitney U or Chi-squared test or Fisher exact test was used for statistical analysis as appropriate.Results A total of 4147 acute stroke patients were enrolled,including 589 patients(14.2%)with hemorrhagic stroke and 3558 patients(85.8%)with ischemic stroke.A total of 750 patients(18.1%)were admitted to the hospital by EMS.The proportion of patients with hemorrhagic stroke who used EMS was higher than that of ischemic stroke(33.4%vs 15.5%,P<0.01).The median onset-to-foor time in the EMS group was less than that in the non-EMS group(1.75 h vs 4.57 h,P<0.01).The median time of onset-to-door time within 1 h in the EMS group was longer than that of the non-EMS group(0.67 h vs 0.53 h,P<0.01).There was no significant difference between the two groups in 1-<2 h period and 2-<3 h period.The median time of onset-to-door time of≥3 h in the EMS group was shorter than that of the non-EMS group(5.0 h vs 9.47 h,P<0.01).In the EMS group,the proportion of patients with onset-to-door time<3 h was higher than that of the non-EMS group(66.13%vs 57.44%,P<0.01).Compared with the non-EMS group,the time of door-to-treatment time was much shorter in the EMS group(87 min vs 101 min,P<0.01).The length of hospital stay in the EMS group was shorter than that of the non-EMS group[11(7,14)days vs 12(6,16)days,P<0.01].In the EMS group,15.9%patients received thrombolytic therapy,whereas only 11.0%patients in the non-EMS group received this therapy(P=0.001).In the EMS group,88.8%patients achieved more favorable outcomes at discharge,which was higher than that in the non-EMS group(85.5%,P=0.02).Conclusions EMS is considered as effective in shortening onset-to-door time,reducing door-to-treatment time,improving thrombolytic rate,reducing hospitalization days,and enhancing the prognosis of acute stroke patients.