急性缺血性脑卒中患者院内延误多因素分析
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摘要
目的探究急性缺血性脑卒中(AIS)患者使用阿替普酶静脉溶栓院内延误因素。方法对经头部CT或磁共振成像确诊的86例AIS患者进行回顾性分析,患者全部接受阿替普酶静脉溶栓治疗,入院时美国国立卫生研究院卒中量表(NIHSS)评分为(12.29±5.77)分。据患者到达医院至使用阿替普酶静脉溶栓的时间(DNT),分为延误组(DNT> 60min,58例)和非延误组(DNT≤60 min,28例)。记录2组基线资料、临床资料,并进一步分析。结果非延误组与延误组120急救系统入院情况、决策者学历、患者家庭收入、入院NHISS评分、入院同型半胱氨酸值、发病到入院时长(ODT)、入院至专科医生接诊时长、患者及家属决策时长差异均具有统计学意义(P <0.05)。多因素Logistic回归分析显示入院NIHSS评分越高(OR=0.748,95%CI:[0.606,0.922],P=0.006)、ODT越长(OR=0.915,95%CI:[0.869,0.915],P=0.001)、患者及亲属决策时长越短(OR=1.258,95%CI:[1.047,1.512],P=0.014),发生溶栓治疗院内延误风险越低。结论 AIS患者院内延误情况严峻,制订严格的诊疗流程,培训专科医生的谈话技巧,加强健康宣教,提高患者对AIS的认识,对缩短院内延误时间具有重要意义。
Objective To investigate into the factors of nosocomial delay in patients with acute ischemic stroke(AIS) treated with intravenous infusion of Alteplase. Methods We retrospectively studied the electronic medical records identifying consecutive 86 cases of patients of acute ischemic stroke, who were all treated by intravenous thrombolytic therapy. Their average score on the National Institutes of Health Stroke Scale(NIHSS) was(12.29±5.77) points at admission. According to door-to-needle time(DNT), patients were divided into either a delay group(DNT > 60 min, n = 58) or non-delayed group(DNT ≤ 60 min, n = 28). The patients' baseline characteristics and clinical data were recorded in two groups. Results There were significant differences in the admission to the emergency center, the education degree of decision makers, annual family income,admission NHISS, admission homocysteine, onset-to-door time(ODT), the time from admission to specialistarrival, the duration of patient or family decision-maker between the two groups(P < 0.05). A multivariate Logistic regression analysis showed that the higher the NIHSS score(OR = 0.748, 95% CI: [0.606, 0.922],P = 0.006), the longer ODT(OR = 0.915, 95% CI: [0.869, 0.915], P = 0.001), the shorter of patients and relatives decision-making time(OR = 1.258, 95% CI: [1.047, 1.512], P = 0.014), the lower risk of hospital-delaying.Conclusion The condition of nosocomial delay with AIS patients is serious. It is imperative that nosocomial delay time be reduced, through a strict implementation of the treatment procedures, training physicians' talking skills, strengthening health education and improving patients' awareness of AIS.
Objective To investigate into the factors of nosocomial delay in patients with acute ischemic stroke(AIS) treated with intravenous infusion of Alteplase. Methods We retrospectively studied the electronic medical records identifying consecutive 86 cases of patients of acute ischemic stroke, who were all treated by intravenous thrombolytic therapy. Their average score on the National Institutes of Health Stroke Scale(NIHSS) was(12.29±5.77) points at admission. According to door-to-needle time(DNT), patients were divided into either a delay group(DNT > 60 min, n = 58) or non-delayed group(DNT ≤ 60 min, n = 28). The patients' baseline characteristics and clinical data were recorded in two groups. Results There were significant differences in the admission to the emergency center, the education degree of decision makers, annual family income,admission NHISS, admission homocysteine, onset-to-door time(ODT), the time from admission to specialistarrival, the duration of patient or family decision-maker between the two groups(P < 0.05). A multivariate Logistic regression analysis showed that the higher the NIHSS score(OR = 0.748, 95% CI: [0.606, 0.922],P = 0.006), the longer ODT(OR = 0.915, 95% CI: [0.869, 0.915], P = 0.001), the shorter of patients and relatives decision-making time(OR = 1.258, 95% CI: [1.047, 1.512], P = 0.014), the lower risk of hospital-delaying.Conclusion The condition of nosocomial delay with AIS patients is serious. It is imperative that nosocomial delay time be reduced, through a strict implementation of the treatment procedures, training physicians' talking skills, strengthening health education and improving patients' awareness of AIS.
引文
[1]殷文明,张小宁.重组组织型纤溶酶原激活剂静脉溶栓治疗急性缺血性脑卒中疗效及安全性的Meta分析[J].中国全科医学, 2014(14):1629—1634
[2]石向群,罗红波,张志强,等.急性缺血性脑卒中胃肠功能紊乱的临床分析[J].兰州大学学报:医学版, 2013,39(4):34—36
[3] Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke:an updated systematic review and Meta-analysis[J]. The Lancet, 2012, 379(9834):2364—2372
[4] El Khoury R, Jung R, Nanda A, et al. Overview of key factors in improving access to acute stroke care[J]. Neurology, 2012, 79(13, Supplement 1):S26—S34
[5] Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44:870—947
[6] Iglesias Mohedano AM, García PA, García AA, et al.Factors associated with in-hospital delays in treating acute stroke with intravenous thrombolysis in a tertiary centre[J].Neurología(English Edition), 2016, 31(7):452—458
[7] Wang Yi-long, Liao Xiao-ling, Zhao Xing-quan, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China:analysis of the results from the Chinese National Stroke Registry(CNSR)[J].Stroke, 2011, 42(6):1658—1664
[8] Mulder MJ, van Oostenbrugge RJ, Dippel DW. Letter by Mulder et al regarding article,"2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment:a guideline for healthcare professionals from the American Heart Association/American Stroke Association"[J]. Stroke, 2015, 46(11):e235
[9] Schwartz A, Money K, Spangehl M, et al. Office-based rapid prototyping in orthopedic surgery:a novel planning technique and review of the literature[J]. American Journal of Orthopedics, 2015, 44(1):19—25
[10] Khatri P, Yeatts SD, Mazighi M, et al. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke:an analysis of data from the interventional management of stroke(IMSⅢ)phase 3 trial[J]. The Lancet Neurology, 2014, 13(6):567—574
[11] Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous Rt-PA versus t-PA alone for stroke[J]. New England Journal of Medicine, 2013,368(10):893—903
[12] Zaidat OO, Yoo AJ, Khatri P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke[J]. Stroke, 2013, 44(9):2650—2663
[13] Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke:a meta-analysis of individual patient data from randomised trials[J]. The Lancet, 2014, 384(9958):1929—1935
[14]胡玉婷.缩短院内延迟在缺血性脑卒中静脉溶栓治疗中的临床价值研究[J].卒中与神经疾病, 2014(5):280—282
[15] K?hrmann M, Schellinger PD, Breuer L, et al. Avoiding in hospital delays and eliminating the threeahour effect in thrombolysis for stroke[J]. International Journal of Stroke Official Journal of the International Stroke Society, 2011, 6(6):493—497
[16] Mikulik R, Kadlecova P, Czlonkowska A, et al. Factors influencing in-hospital delay in treatment with intravenous thrombolysis[J]. Stroke, 2012, 43(6):1578—1583
[17]相启凤,李桂花,黄钟,等.急性缺血性脑卒中动脉溶栓治疗院前与院内延迟的相关因素[J].中华灾害救援医学, 2017, 5(5):246—250
[2]石向群,罗红波,张志强,等.急性缺血性脑卒中胃肠功能紊乱的临床分析[J].兰州大学学报:医学版, 2013,39(4):34—36
[3] Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke:an updated systematic review and Meta-analysis[J]. The Lancet, 2012, 379(9834):2364—2372
[4] El Khoury R, Jung R, Nanda A, et al. Overview of key factors in improving access to acute stroke care[J]. Neurology, 2012, 79(13, Supplement 1):S26—S34
[5] Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44:870—947
[6] Iglesias Mohedano AM, García PA, García AA, et al.Factors associated with in-hospital delays in treating acute stroke with intravenous thrombolysis in a tertiary centre[J].Neurología(English Edition), 2016, 31(7):452—458
[7] Wang Yi-long, Liao Xiao-ling, Zhao Xing-quan, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China:analysis of the results from the Chinese National Stroke Registry(CNSR)[J].Stroke, 2011, 42(6):1658—1664
[8] Mulder MJ, van Oostenbrugge RJ, Dippel DW. Letter by Mulder et al regarding article,"2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment:a guideline for healthcare professionals from the American Heart Association/American Stroke Association"[J]. Stroke, 2015, 46(11):e235
[9] Schwartz A, Money K, Spangehl M, et al. Office-based rapid prototyping in orthopedic surgery:a novel planning technique and review of the literature[J]. American Journal of Orthopedics, 2015, 44(1):19—25
[10] Khatri P, Yeatts SD, Mazighi M, et al. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke:an analysis of data from the interventional management of stroke(IMSⅢ)phase 3 trial[J]. The Lancet Neurology, 2014, 13(6):567—574
[11] Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous Rt-PA versus t-PA alone for stroke[J]. New England Journal of Medicine, 2013,368(10):893—903
[12] Zaidat OO, Yoo AJ, Khatri P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke[J]. Stroke, 2013, 44(9):2650—2663
[13] Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke:a meta-analysis of individual patient data from randomised trials[J]. The Lancet, 2014, 384(9958):1929—1935
[14]胡玉婷.缩短院内延迟在缺血性脑卒中静脉溶栓治疗中的临床价值研究[J].卒中与神经疾病, 2014(5):280—282
[15] K?hrmann M, Schellinger PD, Breuer L, et al. Avoiding in hospital delays and eliminating the threeahour effect in thrombolysis for stroke[J]. International Journal of Stroke Official Journal of the International Stroke Society, 2011, 6(6):493—497
[16] Mikulik R, Kadlecova P, Czlonkowska A, et al. Factors influencing in-hospital delay in treatment with intravenous thrombolysis[J]. Stroke, 2012, 43(6):1578—1583
[17]相启凤,李桂花,黄钟,等.急性缺血性脑卒中动脉溶栓治疗院前与院内延迟的相关因素[J].中华灾害救援医学, 2017, 5(5):246—250