中国云南基层医院远程卒中的有效性和安全性研究
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摘要
目的远程卒中指导基层医院脑梗死静脉溶栓国外已经很成熟,但国内鲜有报道。该研究以上海九院中心与祥云中心建立7×24小时远程卒中合作,由九院中心指导祥云中心进行脑梗死静脉溶栓。方法利用远程卒中前瞻性收集1年内九院中心与祥云中心急性脑梗死病例,统计其静脉溶栓质控和随访情况,对比两中心静脉溶栓率、3小时静脉溶栓率、就诊到静脉溶栓时间(DTN)、发病到静脉溶栓时间(OTT)、3个月随访改良生活能力评分(mRS)及出血、死亡率。结果远程卒中后1年九院中心静脉溶栓率27. 04%,祥云中心静脉溶栓率7. 73%,差异有统计学意义(P=0. 000)。九院中心DTN为(62. 76±26. 41) min,祥云中心DTN为(70. 55±28. 51) min,差异无统计学意义(P> 0. 05)。3个月随访两中心mRS评分、出血和死亡率,差异均无统计学意义(P> 0. 05)。结论远程卒中指导下祥云中心静脉溶栓预后及安全性不差于九院中心,远程卒中是改善农村基层医院静脉溶栓的有效方法之一。
Objective It has been an established practice abroad to assist intravenous thrombolytic therapy for cerebral infarction( CI)with the telestroke program in primary hospitals,but there are rare relevant reports in China. This study is based on a 7 × 24 telestroke program jointly established by the Stroke Center of Shanghai Ninth People's Hospital( Shanghai Center) and the Stroke Center of the People's Hospital of Xiangyun in Yunnan Province,China( Xiangyun Center). Xiangyun Center is supported by Shanghai Center in intravenous thrombolytic therapy for CI. Methods The cases of acute CI within 1 year were prospectively collected from the telestroke program of Shanghai Center and Xiangyun Center,and were summarized for the quality control and follow-up of the cases undergoing an intravenous thrombolysis; the two centers were compared in terms of intravenous thrombolysis rate,intravenous thrombolysis rate within3 hours,door-to-needle( DTN) time,onset-to-treatment( OTT) time,and 3-month follow-up results of the following: modified Rankin Scale( mRS) score,bleeding rate,and mortality. Results Within the 1-year telestroke observation period,there was a significant difference in intravenous thrombolysis rate between the two centers( 27. 04% for Shanghai Center vs 7. 73% for Xiangyun Center,P =0. 000),but there were no significant differences observed between the two centers in DTN time( 62. 76 ± 26. 41 min for Shanghai Center vs 70. 55 ± 28. 51 min for Xiangyun Center,P > 0. 05) or 3-month follow-up results of mRS score,bleeding rate,and mortality( P > 0. 05). Conclusions The prognosis and safety of intravenous thrombolytic therapy under telestroke assistance in Xiangyun Center is not inferior to those of Shanghai Center. Telestroke is an effective method to improve the intravenous thrombolysis rate in primary hospitals in rural areas.
Objective It has been an established practice abroad to assist intravenous thrombolytic therapy for cerebral infarction( CI)with the telestroke program in primary hospitals,but there are rare relevant reports in China. This study is based on a 7 × 24 telestroke program jointly established by the Stroke Center of Shanghai Ninth People's Hospital( Shanghai Center) and the Stroke Center of the People's Hospital of Xiangyun in Yunnan Province,China( Xiangyun Center). Xiangyun Center is supported by Shanghai Center in intravenous thrombolytic therapy for CI. Methods The cases of acute CI within 1 year were prospectively collected from the telestroke program of Shanghai Center and Xiangyun Center,and were summarized for the quality control and follow-up of the cases undergoing an intravenous thrombolysis; the two centers were compared in terms of intravenous thrombolysis rate,intravenous thrombolysis rate within3 hours,door-to-needle( DTN) time,onset-to-treatment( OTT) time,and 3-month follow-up results of the following: modified Rankin Scale( mRS) score,bleeding rate,and mortality. Results Within the 1-year telestroke observation period,there was a significant difference in intravenous thrombolysis rate between the two centers( 27. 04% for Shanghai Center vs 7. 73% for Xiangyun Center,P =0. 000),but there were no significant differences observed between the two centers in DTN time( 62. 76 ± 26. 41 min for Shanghai Center vs 70. 55 ± 28. 51 min for Xiangyun Center,P > 0. 05) or 3-month follow-up results of mRS score,bleeding rate,and mortality( P > 0. 05). Conclusions The prognosis and safety of intravenous thrombolytic therapy under telestroke assistance in Xiangyun Center is not inferior to those of Shanghai Center. Telestroke is an effective method to improve the intravenous thrombolysis rate in primary hospitals in rural areas.
引文
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[11] Hess D, Audebert H. The history and future of telestroke[J]. Nat Rev Neurol, 2013, 9(6):340-350.
[12] Yuan Z,Wang B,Li F,et al. Intravenous thrombolysis guided by a telemedicine consultation system for acute ischaemic stroke patients in China:the protocol of a multicentre historically controlled study[J]. BMJ Open, 2015, 5(5):e006704.
[13] Hubert GJ, Meretoja A, Audebert HJ, et al. Stroke Thrombolysis in a Centralized and a Decentralized System(Helsinki and Telemedical Project for Integrative Stroke Care Network)[J]. Stroke, 2016, 47(12):2999-3004.
[14] Fonarow GC,Smith EE,Saver JL,et al. Improving Door-toNeedle times in Acute Ischemic Stroke:the Design and Rationale for the American Heart Association/American Stroke Association's Target:Stroke Initiative[J]. Stroke,2011,42(10):2983-2989.
[15]王文,朱曼璐,王拥军,等.2012中国心血管病报告[J].中国循环杂志,2013,28(6):408-412.
[16] Audehert HJ, Kukla C, Vatankhah B, et al. Comparison of Tissue Plasminogen Activator Adminisration Management Between Telesroke Network Hospitals and Academic Stroke Centers The Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany[J]. Stroke,2006,37(7):1822-1827.
[17] Legris N,Hervier-Begue M,Daubail B, et al. Telemedicine for the acute management of stroke in Burgundy,France:an evaluation of effectiveness and safety[J]. Eur J Neurol,2016, 23(9):1433-1440.
[18] Zhai YK, Zhu WJ, Hou HL, et al. Efficacy of telemedicine for thrombolytic therapy in acute ischemic stroke:a meta analysis[J]. J Teemed Telecare,2015,21(3):123-130.
[2] Zhao D,Liu J,Wang W,et al. Epidemiological transition of stroke in China:twenty-one-year observational study from the Sino-MONICA-Beijing Project[J]. Stroke, 2008,39(6):1668-1674.
[3] Wang W,Jiang B,Sun H,et al. Prevalence,Incidence and Mortality of Stroke in China:Results from a Nationwide Population-Based Survey of 480,687 Adults[J]. Circulation,2017, 135(8):759-771.
[4] Hacke W,Donnan G,Fieschi C,et al. Association of outcome with early stroke treatment:pooled analysis of ATLANTIS, EC ASS, and NINDS rt-PA stroke trials[J]. Lancet,2004, 363(941 1):768-774.
[5] Switzer JA,Levine SR, Hess DC. Telestroke 1 0 Years Later-'Telestroke 2. 0'[J].Cerebrovasc Dis,2009,28(4):323-330.
[6] Switzer JA, Hall C, Gross H, et al. A Web-based Telestroke System Facilitates Rapid Treatment of Acute Ischemic Stroke Patients in Rural Emergency Department[J]. J EmergMed, 2009, 36(1):12-18.
[7]陈静,金巍,董文帅,等.远程神经病学的应用研究[J].国际神经病学神经外科学杂志,2015, 42(1):92-96.
[8] Audebert HJ, Kukla C, Vatankhah B, et al. Comparison of Tissue Plasminogen Activator Administration Management Between Telestroke Network Hospitals and Academic Stroke Centers The Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany[J]. Stroke,2006,37(7):1 822-1 827.
[9]中华医学会神经病学分会,中华医学会神经病学分会学脑血管病组.中国脑血管疾病分类2015[J].中华神经科杂志,2017, 50(3):168-171.
[10] Wechsler LR, Demaerschalk BM, Schwamm LH, et al. Telemedicine Quality and Outcomes in Stroke:A Scienific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association[J]. Stroke,2017,48(1):e3-e25.
[11] Hess D, Audebert H. The history and future of telestroke[J]. Nat Rev Neurol, 2013, 9(6):340-350.
[12] Yuan Z,Wang B,Li F,et al. Intravenous thrombolysis guided by a telemedicine consultation system for acute ischaemic stroke patients in China:the protocol of a multicentre historically controlled study[J]. BMJ Open, 2015, 5(5):e006704.
[13] Hubert GJ, Meretoja A, Audebert HJ, et al. Stroke Thrombolysis in a Centralized and a Decentralized System(Helsinki and Telemedical Project for Integrative Stroke Care Network)[J]. Stroke, 2016, 47(12):2999-3004.
[14] Fonarow GC,Smith EE,Saver JL,et al. Improving Door-toNeedle times in Acute Ischemic Stroke:the Design and Rationale for the American Heart Association/American Stroke Association's Target:Stroke Initiative[J]. Stroke,2011,42(10):2983-2989.
[15]王文,朱曼璐,王拥军,等.2012中国心血管病报告[J].中国循环杂志,2013,28(6):408-412.
[16] Audehert HJ, Kukla C, Vatankhah B, et al. Comparison of Tissue Plasminogen Activator Adminisration Management Between Telesroke Network Hospitals and Academic Stroke Centers The Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany[J]. Stroke,2006,37(7):1822-1827.
[17] Legris N,Hervier-Begue M,Daubail B, et al. Telemedicine for the acute management of stroke in Burgundy,France:an evaluation of effectiveness and safety[J]. Eur J Neurol,2016, 23(9):1433-1440.
[18] Zhai YK, Zhu WJ, Hou HL, et al. Efficacy of telemedicine for thrombolytic therapy in acute ischemic stroke:a meta analysis[J]. J Teemed Telecare,2015,21(3):123-130.