新型冠状病毒肺炎疫情对卒中绿色通道应用的影响  

Impact of the COVID-19 Pandemic on emergency access(green channel)of stroke

作　　者：黄镪 李昂[1] 赵莹莹[1] 张拥波[1] Huang Qiang;Li Ang;Zhao Yingying;Zhang Yongbo(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,100050

出　　处：《中华脑血管病杂志（电子版）》2021年第3期157-162,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：北京市医院管理中心“青苗”计划专项经费资助(QML20180106);首都卫生发展科研专项(2018-4-2025)。

摘　　要：目的分析新型冠状病毒肺炎(简称新冠肺炎)疫情对急性卒中绿色通道应用效率的影响。方法研究回顾性纳入2020年1月23日至3月22日(疫情初始阶段2020组)和2021年同期(疫情常态化防控阶段2021组),以及2019年同期(2019对照组)连续就诊于首都医科大学附属北京友谊医院并进入卒中绿色通道的病例资料。以发病至入院时间(ODT)的ODT≤360 min的达标率和入院至头颅影像学检查时间(DIT)的DIT≤15 min达标率为主要时间指标,以有无再灌注治疗为主要临床终点指标;采用Mann-Whitney U检验方法比较ODT和DIT的组间差异,采用Pearsonχ^(2)检验比较ODT和DIT达标率的组间差异;利用二元Logistic回归分析本次疫情对卒中绿色通道应用的影响。结果共纳入269例(其中2020组54例,2021组129例和2019对照组86例)急性卒中绿色通道病例。2020组、2021组和2019对照组卒中绿色通道的应用比例分别为5.23%,5.68%和4.06%。相比2019对照组,2020组ODT无明显变化[261(120,409)min vs 249(125,298)min],差异无统计学意义(Z=-1.253;P=0.210),而2021组的ODT则显著延长[420(190,720)min vs 249(125,298)min],差异具有统计学意义(Z=-5.422;P<0.001);而且相比2019对照组的DIT[12(8,22)min],2020组[29(20,42)min]及2021组[34(22,45)min]的DIT均有显著延长,差异均具有统计学意义(Z=-5.806、-8.039,P均<0.001)。主要终点指标比较,2020组及2021组的ODT达标率分别为66.7%和41.9%,均显著低于2019对照组ODT达标率(89.5%),差异均具有统计学意义(χ^(2)=11.144,P=0.001;χ^(2)=49.266,P<0.001);同时2020组及2021组的DIT达标率分别为20.4%和13.2%,也均显著低于2019对照组DIT达标率(58.1%),差异均具有统计学意义(χ^(2)=19.246、48.626,P均<0.001)。此外,2020组及2021组的总体再灌注治疗比例与2019对照组比较,差异均无统计学意义(P均>0.05)。3组均未出现出血转化不良反应事件。多变量Logistic回归分析结果显示新冠肺炎疫情对再灌注治疗无Objective To analyze the effect of the novel coronavirus 2019(COVID-19)Pandemic on the efficiency of emergency access(green channel)for acute stroke.Methods Consecutive acute stroke patients from January 23,2020 to March 22,2020(Group2020),and the same periods in 2021(Group2021)and in 2019(control Group2019)at Beijing Friendship Hospital,Capital Medical University wereretrospectively included in the analysis.The eligible rates of timely onset-to-door time(ODT≤360 min)and door-to-imaging time(DIT≤15 min)were defined as the primary time indicators,and the rate of reperfusion therapy was defined as the primary clinical endpoint event.Mann-Whitney U test was used to compare the differences of ODT and DIT between groups.Pearsonχ^(2) test was used to compare the differences of eligible rates of ODT and DIT.The impact of the COVID-19 Pandemic on the reperfusion therapy of acute ischemic stroke was evaluated by binary Logistic regression model.Results A total of 269 acute stroke cases with green channel(54 in Group2020,129 in Group2021 and 86 in control Group2019)were included.The accessibility of stroke green channel in Group2020,Group2021 and control Group2019 were 5.23%,5.68%and 4.06%,respectively.Compared with control Group2019,the median ODT of Group2020 had no obvious change[261(120,409)min vs 249(125,298)min;Z=-1.253,P=0.210],while the median ODT of Group2021 was significantly prolonged[420(190,720)min vs 249(125,298)min;Z=-5.422,P<0.001].Compared with the median DIT[12(8,22)min]of Group2019,the DIT of Group2020[29(20,42)min]and Group2021[34(22,45)min]were both significantly prolonged(Z=-5.806,-8.039;all P<0.001).The eligibility of ODT(ODT≤360 min)were 66.7%and 41.9%in Group2020 and Group2021,respectively,which were both significantly lower than that in control Group2019(89.5%,χ^(2)=11.144,P=0.001;χ^(2)=49.266,P<0.001).The eligibility of DIT(DIT≤15 min)were 20.4% and 13.2% in Group2020 and Group2021,respectively,which were also both significantly lower than that in control Group2019(58.1%,χ^(2)=19.246,

关 键 词：新型冠状病毒 肺炎 疫情 卒中 绿色通道 再灌注治疗 时间延误 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]