应用移动卒中单元对急性缺血性卒中行院前静脉溶栓的疗效分析

Efficacy analysis for application of mobile stroke unit in prehospital thrombolysis of acute ischemic stroke

目的对比分析应用移动卒中单元(MSU)行院前静脉溶栓与常规静脉溶栓对急性缺血性卒中(AIS)的治疗效果。方法回顾性连续纳入曲靖市第一人民医院神经内科2022年2月至2022年12月行静脉溶栓的AIS患者。收集患者的一般资料及临床资料,包括年龄、性别、吸烟史、高血压病、糖尿病、高脂血症、既往卒中史、心房颤动史、发病时间、静脉溶栓时间、基线美国国立卫生研究院卒中量表(NIHSS)评分、静脉溶栓后48 h症状性颅内出血、静脉溶栓后7 d NIHSS评分、静脉溶栓后90 d改良Rankin量表(mRS)评分、静脉溶栓后90 d死亡及静脉溶栓过程中是否发生任何过敏反应或其他系统出血等。应用MSU进行院前静脉溶栓的AIS患者为MSU溶栓组,院内阿替普酶静脉溶栓(普通急救车入院或自行来院)的AIS患者为常规溶栓组。观察终点指标包括时间指标、疗效指标和安全性指标。时间指标为发病至静脉溶栓时间;疗效指标为静脉溶栓后7 d NIHSS评分、90 d mRS评分;安全性指标包括静脉溶栓后48 h症状性颅内出血、静脉溶栓过程中发生任何过敏反应或其他系统出血及静脉溶栓后90 d患者死亡。结果共纳入151例应用阿替普酶行静脉溶栓的AIS患者,其中男94例(62.3%),女57例(37.7%),年龄39~86岁,中位年龄为67(58,77)岁。MSU溶栓组50例,常规溶栓组101例。两组患者一般资料中年龄、性别、高血压病、高脂血症、心房颤动、吸烟史、卒中史及基线NIHSS评分差异均无统计学意义(均P>0.05),糖尿病史差异有统计学意义(P=0.024)。MSU溶栓组发病至静脉溶栓时间较常规溶栓组明显缩短[93.0(64.5,136.5)min比153.0(118.5,193.5)min,Z=-5.058,P<0.01]。MSU溶栓组溶栓后7 d NIHSS评分低于常规溶栓组[1.0(0.0,3.0)分比2.0(1.0,4.0)分,Z=-2.464,P=0.013],且静脉溶栓后90 d mRS评分较常规溶栓组低[0.0(0.0,0.5)分比0.0(0.0,1.0)分,Z=-2.037,P=0.042]。两组静脉溶栓后48 h症状性颅内出血发生率及90 d内病死率差异均无统计学意义(均P>0.05)。两组患者静脉溶栓过程中均未出现过敏及其他系统出血。结论基于MSU的AIS院前静脉溶栓可以显著缩短发病至静脉溶栓时间,对改善患者神经功能和提高临床疗效具有一定的作用。

Objective To compare and analyze the therapeutic effects of mobile stroke unit(MSU)in prehospital thrombolysis and conventional thrombolysis mode on acute ischemic stroke(AIS).Methods The patients who received intravenous thrombolysis with alteplase(rt-PA)in AIS of the Department of Neurology of Qujing First People′s Hospital from February 2022 to December 2022 were retrospectively included.The general and clinical data were collected,including age,gender,smoking history,hypertension,diabetes,hyperlipidemia,previous stroke history,atrial fibrillation history,onset time,intravenous thrombolysis time,baseline National Institutes of Health Stroke Scale(NIHSS)score,7 d NIHSS score after intravenous thrombolysis,48 h symptomatic intracranial hemorrhage after thrombolysis,90 d modified Rankin scale(mRS)score after thrombolysis,mortality 90 days after thrombolysis and whether allergies or other systemic bleeding occurred.AIS patients who used MSU for intravenous thrombolysis with rt-PA before hospitalization were in MSU thrombolysis group,and AIS patients who received intravenous thrombolysis with rt-PA in hospital(admitted by ordinary ambulance or came to hospital by themselves)were in routine thrombolysis group.The end point of observation included the time indexes,the efficacy indexes and the safety indexes.The time indexe was the time from onset to thrombolysis;the efficacy indexes were NIHSS score for 7 days after thrombolysis;mRS score for 90 days after thrombolysis.The safety indexes were symptomatic intracranial hemorrhage within 48 hours after thrombolysis,mortality 90 days after thrombolysis and whether allergies or other systemic bleeding occurred during thrombolysis.Results A total of 151 AIS patients were enrolled,including 94 males(62.3%)and 57 females(37.7%),with a median age of 67(58,77)years.There were 50 patients in MSU thrombolysis group and 101 patients in the routine thrombolysis group.There were no significant difference in basic characteristics,including age,gender,hypertension,smoking history,hyperlipidemia,atrial fibrillation,previous stroke history and baseline NIHSS score,between the two groups(all P>0.05)except diabetes with a significant difference(P=0.024).Compared with the routine thrombolysis group,the time from onset to thrombolysis in MSU thrombolysis group was significantly shortened(93.0[64.5,136.5]min vs.153.0[118.5,193.5]min,Z=-5.058,P<0.01).The 7 d NIHSS score in MSU thrombolysis group was lower than that in the routine thrombolysis group(1.0[0.0,3.0]score vs.2.0[2.0,4.0]score,Z=-2.464,P=0.013),and the 90 d mRS score in MSU thrombolysis group was lower than that in the routine thrombolysis group(1.0[0.0,0.5]score vs.0.0[0.0,1.0]score,Z=-2.037,P=0.042).There was no significant difference between the two groups in symptomatic intracranial hemorrhage within 48 hours after thrombolysis and mortality 90 days after thrombolysis(both P>0.05).There was no allergic reaction or other systemic bleeding during thrombolysis in the two groups.Conclusion Pre-hospital intravenous thrombolysis in AIS based on MSU can significantly shorten the time from onset to intravenous thrombolysis,which has a certain effect on improving the recovery of neurological function and improving clinical efficacy.