院前转运方式对急性缺血性卒中静脉溶栓时间效率指标及早期神经功能改善的影响研究  

Effects of pre-hospital transfer mode on time-efficiency indexes and early neurological function improvement in acute ischemic stroke receiving intravenous thrombolysis

作　　者：曾昊[1] 张幼林[1] 杨卫兴 彭雅卓[1] 宋宏杰[1] 赵文艳 王丽靖[1] Zeng Hao;Zhang Youlin;Yang Weixing;Peng Yazhuo;Song Hongjie;Zhao Wenyan;Wang Lijing(Department of Neurology,Beijing Fengtai Hospital,Beijing 100070,China)

机构地区：[1]北京丰台医院神经内科,100070

出　　处：《中国脑血管病杂志》2022年第2期94-100,121,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市丰台区卫生计生系统科研项目(2018-41)。

摘　　要：目的分析院前转运方式对急性缺血性卒中患者入院后静脉溶栓时间效率指标及早期神经功能改善的影响。方法回顾性连续纳入2018年6月至2021年5月北京丰台医院神经内科急性缺血性卒中接受静脉溶栓治疗患者302例,均经头部CT或MR证实有新发梗死灶,并在院内接受静脉溶栓治疗,排除了静脉溶栓桥接取栓治疗患者。根据登记的院前转运方式,将通过“120”或“999”等急救系统到院的患者分为急救转运组,自驾或出租车等其他非急救系统到院方式者分为自行就诊组;根据早期神经功能是否改善,将患者分为早期神经功能改善组和未改善组。分别记录并比较两组患者的人口学资料(年龄、性别等)、动脉粥样硬化的危险因素(高血压病、糖尿病、高脂血症、冠心病、心房颤动及卒中史)及临床资料[就诊时指尖血糖、血压、美国国立卫生研究院卒中量表(NIHSS)评分,发病前改良Rankin量表(mRS)评分,溶栓后24 h NIHSS评分等]。早期神经功能改善定义为静脉溶栓后24 h NIHSS评分较基线减少≥4分或溶栓后24 h NIHSS评分为0分。以早期神经功能改善为因变量,将单因素分析中P<0.1的参数纳入多因素Logistic回归分析,以观察院前转运方式对早期(溶栓后24 h)神经功能改善的影响。结果(1)302例接受静脉溶栓治疗的急性缺血性卒中患者中,急救转运组123例(40.7%),自行就诊组179例(59.3%)。急救转运组患者年龄、就诊时血糖均大于自行就诊组,男性及合并高血压病、冠心病和心房颤动比例均高于自行就诊组,组间差异均有统计学意义[(70±13)岁比(64±12)岁,t=-3.916;8(6,10)mmol/L比7(6,9)mmol/L,Z=-2.578;74.8%(92/123)比61.5%(110/179),χ^(2)=5.861;66.7%(82/123)比53.6%(96/179),χ^(2)=5.119;26.8%(33/123)比15.6%(28/179),χ^(2)=5.660;18.7%(23/123)比3.9%(7/179),χ^(2)=17.812;均P<0.05],糖尿病、高脂血症、卒中史、血压、发病前mRS评分的组间差异均无统计�Objective To investigate the effect of pre-hospital transfer mode on time-efficiency indexes and early neurological function improvement of intravenous thrombolysis for acute ischemic stroke patients after admission.Methods A total of 302 patients with acute ischemic stroke who received intravenous thrombolysis in Department of Neurology,Beijing Fengtai Hospital from June 2018 to May 2021 were retrospectively enrolled.All patients had new infarcts confirmed by head CT or MR and received intravenous thrombolysis in hospital.Intravenous thrombolytic bridging thrombectomy were excluded.According to the registered pre-hospital transfer mode,the patients were classified as emergency transfer group if arriving at the hospital through“120”or“999”emergency system and the self-treatment group if through other non-emergency system such as self-driving by families or taxi.The patients were also divided into early neurological improvement group and non-early neurological improvement group according to whether the early neurological function was improved or not.Demographic data[age,gender,etc.],atherosclerosis risk factors[hypertension,diabetes mellitus,hyperlipidemia,coronary heart disease,atrial fibrillation and stroke history]and clinical data[fingertip blood glucose,blood pressure,National Institutes of Health Stroke Scale(NIHSS)score at visit,modified Rankin scale(mRS)score before onset,NIHSS score 24 h after thrombolysis,etc.]were recorded and compared between two groups.Early neurological improvement was defined as NIHSS score reduction≥4 from baseline or NIHSS score of 0 at 24 h after thrombolysis.Taking early neurological improvement as the dependent variable,the covariates with P<0.1 in univariate analysis were included in multivariate Logistic regression analysis to observe the effect of pre-hospital transfer mode on early neurological improvement(24 h after thrombolysis).Results(1)Among 302 acute ischemic stroke patients who received intravenous thrombolysis,123(40.7%)were in the emergency transfer group

关 键 词：卒中 急救医疗服务 影响因素分析 缺血性卒中 院前转运 时间效率指标 早期神经功能改善 

分 类 号：R743.3[医药卫生—神经病学与精神病学]