院内急性缺血性脑卒中急诊闭塞开通救治延误原因分析

Emergency endovascular recanalization of in-hospital acute ischemic stroke:analysis of the causes of delayed treatment

目的探讨院内急性缺血性脑卒中急诊血管内开通救治延误的原因。方法回顾性分析2018年1月至2019年12月在河南省人民医院住院期间发生急性大动脉闭塞性脑梗死并接受急诊血管内治疗患者临床资料。根据患者发病至股动脉穿刺时间分为延误组>120 min和非延误组≤120 min。收集两组患者基线资料、术中影像及术后90 d改良Rankin量表(mRS)评分,分析院内脑卒中血管内开通救治延误的原因。结果共纳入院内脑卒中患者34例(延误组n=22,非延误组n=12),中位年龄68.0(56.0,73.5)岁,其中男24例(70.6%)。中位发病至股动脉穿刺时间(OPT)为233(110.7,300.0)min。非延误组发病至会诊时间(42.0 min比137.0 min,P<0.001)、影像检查至股动脉穿刺时间(43.0 min比130 min,P<0.001)均显著短于延误组;出院时美国国立卫生研究院卒中量表(NIHSS)评分(6.5比10.0,P=0.032)低于延误组,90 d良好预后比率(66.7%比18.2%,P=0.008)高于延误组。二元logistic回归分析显示,发病至会诊时间(OR=0.905,95%CI=0.818~1.000,P=0.049)、影像检查至股动脉穿刺时间(OR=0.944,95%CI=0.907~0.983,P=0.005)延长是院内脑卒中救治延误的独立危险因素,高危科室发病(OR=6.800,95%CI=1.428~32.373,P=0.016)是减少院内脑卒中救治延误的独立影响因素。结论及时识别院内非高危科室发病的急性缺血性脑卒中,缩短发病至会诊时间和影像检查至股动脉穿刺时间,可有效减少院内脑卒中救治延误。

Objective To discuss the causes of delayed treatment in treating in-hospital acute ischemic stroke(AIS)with emergency endovascular recanalization.Methods The clinical data of patients,who developed in-hospital AIS and received emergency endovascular recanalization during the period from January 2018 to December 2019 at the Henan Provincial People's Hospital of China,were retrospectively analyzed.Based on the onset-to-puncture time(OPT),the patients were divided into delayed group(>120 min)and non-delayed group(≤120 min).The baseline data,intraoperative imaging materials and postoperative 90-day modified Rankin Scale(mRS)score of patients of both groups were collected,and the causes of delayed treatment were analyzed.Results A total of 34 patients with in-hospital AIS were enrolled in this study,including 22 patients in the delayed group and 12 patients in the non-delayed group.The median age was 68 years(56.0,73.5 years),and 24 patients were males(70.6%).The median OPT was 233.0 min(110.7,300.0 min).In the nondelayed group,the onset-to-consultation time was 42.0 min,which was remarkably shorter than 137.0 min in the delayed group(P<0.001),the imaging-to-puncture time was 43.0 min,which was obviously shorter than 130.0 min in the delayed group(P<0.001),the National Institutes of Health Stroke Scale(NIHSS)score at the time of discharge was 6.5 points,which was lower than 10.0 points in the delayed group(P=0.032),the postoperative 90-day good prognosis rate was 66.7%,which was prominently higher than 18.2%in the delayed group(P=0.008).Binary logistic regression analysis showed that the onset-to-consultation time(OR=0.905,95%CI=0.818-1.000,P=0.049),the imaging-to-puncture time(OR=0.944,95%CI=0.907-0.983,P=0.005)were the independent risk factors for the delay of rescue treatment of in-hospital AIS,while the onset of stroke in a high-risk department(OR=6.800,95%CI:1.428-32.373,P=0.016)was an independent factor for reducing the delay of rescue treatment of in-hospital AIS.Conclusion Timely identifying in-hospital AIS occurring in the non-high-risk departments,shortening the onset-to-consultation time and shortening the imaging-to-puncture time can effectively reduce the delay of rescue treatment of in-hospital AIS.