鄂尔多斯地区脑梗死院前患者延误的影响因素  

Influencing factors of prehospital delay in patients of acute ischemic stroke the findings from Erdos, Inner Mongolia

作　　者：孙锐[1] 王俊梅[1] 吴迎春[1] 马梅林[1] 王哲[1] SUN Rui;WANG Jun-mei;WU Yin-chun;MA Mei-lin;WANG Zhe(Department of Neurology, the Erdos Center Hospital, Inner Mongolia 017000, China)

机构地区：[1]鄂尔多斯市中心医院神经内科二区,内蒙古017000

出　　处：《脑与神经疾病杂志》2017年第1期37-41,共5页Journal of Brain and Nervous Diseases

摘　　要：目的探讨鄂尔多斯地区脑梗死(CI)患者院前延误的特征和影响因素。方法前瞻性连续登记2012年1月1日至2015年12月31日期间因CI入院的患者,采用问卷和访视调查方法调查院前延误(从卒中症状出现至做出就医决定)和运送所需时间(从做出就医决定至到达医院),记录卒中现场情况、认识行为和社会人口学变量等,采用单变量和多变量分析方法研究院前延误的影响因素。结果纳入490例,其中147例(30%)发病2h内做出就医决定(早期就医决定组),343例(70%)发病2 h后做出就医决定(延误决定就医组)。NIHSS评分、Barthel指数、以意识障碍起病、既往因脑卒中曾住院治疗、发病现场认识到卒中、发病现场有家属或同事、症状进行性加重、患者或家属或同事知晓溶栓治疗对院前时间差异有统计学意义。是否使用120救护车对院前时间有显著性影响。多变量Logistic回归分析显示,发病时有家属或同事或既往因脑卒中曾住院治疗是促进早期决定就医的独立影响因素,而症状较轻或夜间发病是造成就医定延误的独立影响因素。结论就医决定延误是本地区CI院前延误的主要原因,家属或同事或既往因脑中曾住院是减少决定延误的重要因素,普及本地区居民卒中知识、增加使用救护车及改善本地区医院布可能使更多脑梗死患者获益。Objective To investigate the characteristics of prehospital delay and influencing factors in patients with acute ischemic stroke in Erdos, Inner Mongolia. Method Consecutive inpatients with acute ischemic stroke were registered prospectively from Jan 1,2012 to Dec 31,2015. Questionnaires and interviews were used to investigate the pre-hospital delay(from the time of stroke onset to decision to seek medical help) and the time needed for transportation(from medical decision to arriving at the hospital). The variables such as the scene of stroke,cognitive behavior, and sociodemography were documented. Univariate and multivariate analyses were used to study the influencing factors for prehospital delay.Results A total of 490 patients with acute ischemic stroke were enrolled,and 147 of them(30%)made decision to seek medical help within 2 hours after symptom onset(early decision group);343( 70%)of them made decision to seek medical help after 2 hours of symptom onset(decision delay group). NIHSS scores, Barthel index, disturbance of consciousness, ever patients suffered from stroke, the proportions of presence of bystander at the time of symptom onset, awaring of the onset of stroke, progression of symptoms, knowing thrombolytic treatment in the early decision group were significantly higher than those in the decision delay group; there were significant difference in the proportions of transport modes between the early decision group and the decision delay group. Multivariate logistic regression analysis showed that presence of bystander at the time of symptom onset or ever suffered from stroke was an independent influencing factor for early decision to seek medical help, while the light symptom or the onset at night was the independent influencing factors for decision delay. Conclusion The decision delay to seek medical help is a main reason for prehospital delay in acute ischemic stroke in Erdos. Presence of bystander at the time of symptom onset or ever suffered from stroke is an important factor for decreasing deci

关 键 词：脑梗死 院前时间 延误 时间因素 

分 类 号：R743.32[医药卫生—神经病学与精神病学]