应用移动卒中单元对急性缺血性卒中院前静脉溶栓的初步探索  

Application of Mobile Stroke Unit in Prehospital Thrombolysis of Acute Ischemic Stroke

作　　者：周腾飞 朱良付[1] 李天晓[1] 李玉成[1] 王梅云[1] 刘焕 武宏坤 赵俊涛 裴全森 陈伟峰 ZHOU Teng-Fei;ZHU Liang-Fu;LI Tian-Xiao;LI Yu-Cheng;WANG Mei-Yun;LIU Huan;WU Hong-Kun;ZHAO Jun-Tao;PEI Quan-Sen;CHEN Wei-Feng(Department of Intervention,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Stroke Center,Xingyang People’s Hospital,Xingyang 450000,China)

机构地区：[1]河南省人民医院介入科,郑州450003 [2]荥阳市人民医院卒中中心

出　　处：《中国卒中杂志》2020年第3期263-268,共6页Chinese Journal of Stroke

基　　金：河南省医学科技攻关计划项目（SBGJ2018063）;国家脑卒中高危人群干预适宜技术研究及推广项目（GN-2018R0007）

摘　　要：目的大多数急性缺血性卒中患者难以在发病早期接受静脉溶栓治疗,而移动卒中单元(mobile stroke unit,MSU)的应用将静脉溶栓治疗从院内提到院前。本研究初步探讨中国首台MSU在急性卒中患者院前静脉溶栓中的作用。方法回顾性分析荥阳市人民医院卒中中心2018年11月-2019年4月期间应用MSU进行院前静脉溶栓的患者(MSU溶栓组)和使用传统救护车转运至院内静脉溶栓的患者(常规溶栓组)的临床资料。观察终点包括主要时间指标从呼叫至溶栓时间、从发病至溶栓时间;疗效指标为90 d良好预后(mRS评分≤2分)率;安全性指标包括溶栓后48 h内症状性颅内出血及随访90 d内的全因死亡。比较静脉溶栓患者应用两种治疗模式的终点差异。结果MSU溶栓组共计14例患者接受了院外静脉溶栓,同时期常规溶栓组有24例患者在院内进行了静脉溶栓治疗。与常规溶栓组相比,MSU溶栓组呼叫至溶栓时间(59 min vs 92 mi n,P=0.001)、发病至溶栓时间(73 min vs 114 mi n,P=0.002)均较短。两组的90 d良好预后率(79%vs 67%,P=0.488)和安全性指标均未见统计学差异。结论基于MSU的急性缺血性卒中院前溶栓可以显著缩短患者从发病至溶栓时间及呼叫至溶栓时间,但对于急性卒中的救治疗效仍需要多中心前瞻性研究进一步验证。Objective Most acute ischemic stroke patients cannot receive intravenous thrombolytic therapy in the early stage of stroke onset,however,the application of mobile stroke unit(MSU)in prehospital intravenous thrombolytic therapy for acute stroke may change this situation.This study aimed to investigate the effectiveness of MSU in prehospital thrombolysis for acute ischemic stroke patients.Methods This was a retrospective study,which enrolled patients who received prehospital intravenous thrombolysis using MSU(MSU thrombolysis group)and patients transferred to the emergency department via traditional ambulances for intravenous thrombolysis(control group)in stroke center of Xingyang People’s Hospital between November 2018 and April 2019.The observational end-points included primary time measurements(alarm-to-thrombolysis time and onset-to-thrombolysis time),the rate of 90-day good prognosis(a mRS score of 0-2)and safety outcome(symptomatic intracranial hemorrhage within 48 hours since thrombolytic therapy and all-cause mortality during the 90-day follow-up).The difference of the end-points between the two groups were compared.Results A total of 14 patients in MSU thrombolysis group and 24 patients in control group.The alarm-to-thrombolysis time(59 min vs 92 min,P=0.001)and onset-to-thrombolysis time(73 min vs 114 min,P=0.002)in MSU thrombolysis group were both shorter than that in control group.There were no statistical difference in the rate of good prognosis at 90 days(79%vs 67%,P=0.488)and safety outcome between MSU thrombolysis group and control group.Conclusions The application of MSU in prehospital intravenous thrombolysis significantly reduced the alarm-to-thrombolysis time and onset-to-thrombolysis time,while the efficacy of MSU in the treatment of acute stroke need to be further validated by multi-center prospective trials.

关 键 词：急性卒中 移动卒中单元 院前静脉溶栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]