脑卒中中心成立对卒中患者救治效果的影响——附310例急性缺血性脑卒中患者的救治分析

Retrospective analysis of 310 cases of acute ischemic stroke:the impact of establishment of stroke center on the treatment effect

目的探讨脑卒中中心的建立对急性缺血性脑卒中(AIS)患者院内救治效果的影响。方法回顾性分析湖南师范大学附属第一医院急诊科脑卒中中心收治的310例AIS患者的临床资料,以卒中中心成立前收治的90例患者为对照组,以中心成立后收治的220例患者为观察组。对照组按普通急诊流程就诊;观察组到达急诊后立即启动脑卒中绿色通道,按脑卒中中心流程救治。收集两组患者基线资料〔如性别、年龄、吸烟史、饮酒史、血压、血糖、血脂、既往病史、入院时美国国立卫生研究院卒中量表(NIHSS)评分〕以及入院干预措施和可控因素〔包括急诊科滞留时间、发病至急诊时间、急诊至取血化验结果报告时间、急诊至CT检查报告时间、溶栓和介入治疗例数、发病到院至溶栓时间(DNT)、急诊至股动脉穿刺时间(DPT)、发病到院至再灌注时间(DRT)〕;主要观察指标为病死率,次要观察指标为住院时间、住院费用;比较两组上述指标及正常出院患者出院时NIHSS评分、出院与入院NIHSS评分差值、住院时间、住院费用等的差异。结果两组患者基线资料中除总胆固醇(TC)、低密度脂蛋白(LDL)、入院时NIHSS评分比较差异均有统计学意义外,其余基线资料比较差异均无统计学意义。两组患者发病至急诊时间、介入治疗比例、病死率、住院费用等比较差异均无统计学意义;但观察组溶栓比例较对照组明显增多〔33.2%(73)比10.0%(9)〕,且急诊科滞留时间、住院时间、急诊至取血化验结果报告时间、急诊至CT检查报告时间、DNT、DPT、DRT均较对照组明显缩短〔急诊科滞留时间(h):2.3(1.4,4.1)比6.1(2.9,12.5),住院时间(d):8(6,11)比11(8,13),急诊至取血化验结果报告时间(min):14.0(11.0,19.0)比49.0(33.5,62.8),急诊至CT检查报告时间(min):54.0(30.3,86.0)比105.0(73.5,148.0),DNT(min):27.8±16.2比130.9±58.3,DPT(min):95.2±37.8比214.7±64.6,DRT(min):178.3±58.6比366.2±113.9,均P<0.05〕。两组中正常出院患者出院时NIHSS评分、住院费用比较差异均无统计学意义,但观察组出院患者住院时间更短〔d:9.0(7.0,11.0)比11.0(8.5,13.0)〕,出院和入院NIHSS评分差值更小〔分:-2(-4,0)比-1(-3,0)〕,差异均有统计学意义(均P<0.05)。结论脑卒中中心建立可以提高AIS患者院内救治效率,缩短住院时间,改善患者短期预后。

Objective To explore the impact of the establishment of stroke center on the treatment of hospitalized patients with acute ischemic stroke(AIS).Methods The clinical data of 310 AIS patients admitted to the Stroke Center of the Emergency Department of the First Affiliated Hospital of Hunan Normal University were retrospectively analyzed,90 patients admitted before the establishment of the center as the control group,and 220 patients admitted after it as the observation group.The control group followed the general emergency treatment procedure,and the observation group immediately started the stroke green channel while arriving at the emergency department,and was treated according to the stroke center procedure.Baseline data[including gender,age,smoking history,drinking history,blood pressure,blood glucose,blood lipids,past medical history,National Institutes of Health Stroke Scale(NIHSS)score at the time of admission],admission interventions,as well as available controlling factors[including department of emergency stay time,time from onset to emergency department,time from emergency department to blood result report,time from emergency department to CT examination report,number of thrombolysis and interventional treatment,door to needle time(DNT),door to puncture time(DPT),door to recanalization time(DRT)]were compared between the two groups.Compare the two main observational indicators(mortality rate)and secondary observational indicators(hospitalization time,hospitalization expenses).Compare the NIHSS score at discharge,the disparity of NIHSS between admission and discharge,hospitalization time,hospitalization expenses of the two groups of normal discharged patients.Results There were no statistically significant differences in baseline data between the two groups except for total cholesterol(TC),low-density lipoprotein(LDL),and NIHSS score at admission.There was no significant difference between the two groups in the time from onset to emergency department,proportion of interventional treatment,mortality,and hospitalization costs.However,the proportion of thrombolytic treatment in observation group increased significantly compared with the control group[33.2%(73)vs.10.0%(9)],and the department of emergency stay time,hospitalization time,time from emergency department to blood result report,time from emergency department to CT examination report,DNT,DPT,DRT were significantly shortened compared with the control group[department of emergency stay time(hours):2.3(1.4,4.1)vs.6.1(2.9,12.5),hospitalization time(days):8(6,11)vs.11(8,13),time from emergency department to blood draw result report(minutes):14.0(11.0,19.0)vs.49.0(33.5,62.8),time from emergency department to CT examination report(minutes):54.0(30.3,86.0)vs.105.0(73.5,148.0),DNT(minutes):27.8±16.2 vs.130.9±58.3,DPT(minutes):95.2±37.8 vs.214.7±64.6,DRT(minutes):178.3±58.6 vs.366.2±113.9,all P<0.05].There was no statistically significant difference in the discharge NIHSS and hospitalization expenses in the two groups of normal discharged patients,but the observation group had shorter hospitalization time[days:9.0(7.0,11.0)vs.11.0(8.5,13.0)],the disparity of NIHSS between admission and discharge was smaller[-2(-4,0)vs.-1(-3,0)],and the difference was statistically significant(all P<0.05).Conclusion The establishment of stroke center can improve the efficiency of hospital treatment for AIS patients,shorten the hospitalization time,and improve the short-term prognosis of patients.