全前循环梗死患者的超早期溶栓延迟的因素分析及改进建议

Analysis of Factors Causing Ultra-Early Delayed Thrombolysis in Patients with Total Anterior Circulation Infarction and Suggestions for Improvement

目的:分析全前循环梗死患者的超早期溶栓延迟的因素,并提出改进建议。方法:对某院2015年8月~2019年6月收治的215例全前循环梗死患者的临床资料进行回顾,分析超早期溶栓延迟的危险因素。结果:本组患者超早期溶栓延迟发生率为28.84%,超早期溶栓延迟发生者中不良预后发生率高于未发生者,差异有统计学意义(P<0.05);超早期溶栓延迟发生者24∶00~05∶59时间段发病、独居、NIHSS评分≥15分、主要照护家属不了解超早期溶栓、发病地点离医院距离>5km、未拨打120急救电话、存在溶栓治疗禁忌症者构成比均高于未发生者,差异均有统计学意义(P<0.05),且经Logistic回归分析可知上述因素均是超早期溶栓延迟的独立危险因素。结论:全前循环梗死患者超早期溶栓延迟现象常见,且发生者预后不良风险高,24∶00~05∶59时间段发病、独居等均是其危险因素,需重点防控。

Objective:To analyze the factors of ultra-early delayed thrombolysis in patients with total anterior circulation infarction and put forward suggestions for improvement. Methods:The clinical data of 215 patients with total anterior circulation infarction admitted to a hospital from Aug 2015 to June 2019 were reviewed. The factors for delayed thrombolysis were analyzed. Results: The incidence rate of delayed early thrombolysis was 28.84%, and the incidence of adverse prognosis in patients with delayed early thrombolysis was significantly higher than those without delayed early thrombolysis, with a statistically significant difference(P<0.05). The ratios of delayed occurrence of ultra-early thrombolysis occurred in 24∶00~05∶59 time intervals, including onset, solitude, NIHSS score ≥15, primary care families are not aware of ultra-early delayed thrombolysis, distance from the onset site to hospital >5 km, no 120 emergency telephone calls, contraindication of thrombolytic therapy were higher than those of the non-occurrence group, with statistically significant differences(P<0.05). Logistic regression analysis showed that these factors were independent risk factors for delayed thrombolysis(P<0.05). Conclusion:Ultra-early delayed thrombolysis is common in patients with total anterior circulation infarction, and the risk of poor prognosis is high. Onset in 24∶00~05∶59 and solitary living and so on are the risk factors, which need to be focused on prevention and control.