广安市缺血性脑卒中患者超急性期救治延误风险的危险因素分析

Risk factors of delayed pre-hospital treatment in patients with hyperacute ischemic stroke in Guang'an

目的研究广安市缺血性脑卒中患者超急性期救治延误风险的危险因素分析。方法收集广安市多所医院2020年7月—2021年6月收治503例缺血性脑卒中患者临床资料,调查患者超急性期救治情况,并分析院外延误相关因素。结果统计发现,本研究503例缺血性脑卒中患者中,院外延误时间>3.5 h者共330例,院外延误时间≤3.5 h者共173例,根据以上结果,将被调查对象分为>3.5 h组(n=330)与≤3.5 h组(n=173),先后进行Logistic单因素及多因素回归分析提示,既往脑梗史[比值比(oddsratio,OR)=0.151,95%置信区间(CI)(0.077~0.297)]、发病时有意识改变[OR=0.170,95%CI(0.062~0.467)]、采用120救护车转运[OR=0.444,95%CI(0.343~0.576)]、由旁人首先发现症状[OR=0.259,95%CI(0.115~0.588)]是院外延误时间>3.5 h的保护因素,而发病时头痛[OR=5.441,95%CI(2.270~13.042)]、转院[OR=2.201,95%CI(1.696~2.857)]是院外延误时间>3.5 h的危险因素。结论加大缺血性脑卒中相关健康宣教力度,向市民普及缺血性脑卒中临床表现、高危因素、送诊方式等相关知识,在缩短患者发病至入院时间,提高时间窗内溶栓率,改善患者预后中具有重要意义。

Objective To analyze the risk factors of delayed pre-hospital treatment in patients with hyperacute ischemic stroke in Guang'an.Methods The clinical data of 503 patients with hyperacute ischemic stroke admitted to several hospitals in Guang'an from July 2020 to June 2021 were collected.Then the factors of delayed pre-hospital treatment were analyzed.Results Statistics analysis showed that there were 330 cases with delayed prehospital treatment time over 3.5 h and 173 cases with delayed pre-hospital treatment time less than 3.5 h,and were set as>3.5 h group and≤3.5 h group,respectively.Logistic univariate and multivariate regression analysis indicated that previous history of cerebral infarction[OR=0.151,95%CI(0.077~0.297)],altered consciousness at onset[OR=0.170,95%CI(0.062~0.467)],ambulance transport[OR=0.444,95%CI(0.343~0.576)],first detection of symptoms by a bystander[OR=0.259,95%CI(0.115~0.588)]were protective factors for pre-hospital delay time>3.5h,while headache at onset[OR=5.441,95%CI(2.270~13.042)]and hospital transfer[OR=2.201,95%CI(1.696~2.857)]were risk factors for pre-hospital delay>3.5 h.Conclusion Health education on ischaemic stroke and the dissemination of knowledge on the clinical manifestations,high-risk factors and admission methods of ischaemic stroke are important in reducing the time from onset to hospital admission,increasing the thrombolysis rate within the time window and improving the prognosis of patients.