新疆哈密地区急性脑梗死院前延误的相关因素及对预后的影响

Related factors of pre-hospital delay in acute cerebral infarction and its effect on prognosis in Hami area of Xinjiang

目的分析新疆哈密地区急性脑梗死院前延误的相关因素及其对预后的影响。方法2016年1月-2017年12月,收集来自新疆哈密地区的急性脑梗死住院患者,按照发病至到院时间是否≥3 h分为院前延误组和及时就诊组,比较2组一般资料、社会行为学资料、发病特征和既往病史等因素并进行多因素logistic回归分析;比较2组早期(入院2周后)神经功能及预后情况。结果及时就诊组患者占总体患者的18.98%。多因素logistic回归分析显示,自费医疗、单独居住、非城市居住、睡醒时发现及高血压史是院前延误的独立危险因素,年龄≥60岁、认识脑梗死治疗紧迫性、救护车转运、语言障碍、意识障碍、认知功能障碍及心房颤动病史是院前延误的保护因素。及时就诊组入院2周后(t=2.161,P<0.05)及出院后6个月(t=2.198,P<0.05)的美国国立卫生研究院(NIHSS)脑卒中量表评分低于院前延误组,早期神经功能好转率(64.04%vs51.58%,χ^2=4.511,P<0.05),出院后6个月生活能力评分高于院前延误组(t=2.007,P<0.05)。结论哈密地区院前延误率较高,主要与医保、居住环境、疾病认知、合并病史、发病症状等因素相关,且院前延误的患者早期神经功能恢复及预后相对较差。

Objective To analyze the related factors of pre-hospital delay of acute cerebral infarction in Hami area of Xinjiang and its influence on prognosis.Methods The inpatients with acute cerebral infarction from Hami area of Xinjiang were divided into pre-hospital delayed group and timely treatment group according to whether the time from onset to hospitalization was more than three hours.The general data,social behavior data,morbidity characteristics and past medical history of the two groups were compared,and multivariate logistic regression analysis was performed.The early stage neurological function(two weeks after admission)and prognosis of the two groups were compared.Results The patients in the timely treatment group accounted for 18.98%of the total patients.Multivariate logistic regression analysis showed that self-paid medical treatment,living alone,non-urban residence,onset at waking up and history of hypertension were risk factors for pre-hospital delay,while age(≥60 years old),awareness of the urgency of cerebral infarction treatment,ambulance transport,language disorders,consciousness disorders,cognitive impairment and the history of atrial fibrillation were the protective factors for pre-hospital delay.The score of the National Institutes of Health(NIHSS)stroke scale two weeks after admission(t=2.161,P<0.05)and six months after discharge(t=2.198,P<0.05)in the timely treatment group was significantly lower than those in the pre-hospital delay group.The improvement rate of neurological function in the early stage(64.04%vs 51.58%,χ^2=4.511,P<0.05),and the life ability score in the six months after discharge(t=2.007,P<0.05)were significantly higher than those in the pre-hospital delay group(P<0.05).Conclusion Pre-hospital delay rate is high in Hami area,which is mainly related to medical insurance,living environment,disease cognition,complication with other diseases,symptoms and other factors,and the early recovery of neural function and prognosis of patients with pre-hospital delay are relatively poor.