工作时间效应对急性前循环大血管闭塞性卒中患者早期血管内治疗流程及预后的影响  

Influence of working time effect on early endovascular treatment process and outcomes in patients with acute large vessel occlusion stroke of anterior circulation

作　　者：吴康飞 孙毅 王昊[1] 纪亚晨 郭亚鹏 杨科 许向军 周志明[1] 黄显军[1] 杨倩[1] Wu Kangfei;Sun Yi;Wang Hao;Ji Yachen;Guo Yapeng;Yang Ke;Xu Xiangjun;Zhou Zhiming;Huang Xianjun;Yang Qian(Department of Neurology,Yijishan Hospital of Wannan Medical College,Wuhu 241000,China)

机构地区：[1]皖南医学院弋矶山医院神经内科,安徽省芜湖市241000

出　　处：《中国脑血管病杂志》2022年第9期593-601,共9页Chinese Journal of Cerebrovascular Diseases

基　　金：安徽省高校自然科学研究项目(KJ2021A0843);皖南医学院中青年科研基金(WK2020F24);皖南医学院教学研究项目(2020jyxm81)。

摘　　要：目的 探讨“工作时间效应”对前循环急性大血管闭塞性缺血性卒中(AIS-LVO)患者早期血管内治疗(EVT)流程和预后的影响。方法 回顾性连续纳入2019年2月至2021年3月于皖南医学院弋矶山医院高级卒中中心接受EVT的前循环AIS-LVO患者。根据入组患者到院时间分为工作时间(工作日的08∶00—17∶00)组和非工作时间(工作时间以外的所有时间)组,并对非工作时间组患者进行夜间(22∶00至次日07∶59)入院与非夜间(08∶00—21∶59)入院的亚组分析。收集所有入组患者的基线资料、各流程时间间隔、术后90 d改良Rankin量表(mRS)评分等,并对影响诊治流程和预后的因素进行分析。主要结局指标为术后90 d mRS评分,次要结局指标为闭塞血管再通情况和症状性颅内出血。结果 共纳入303例患者,平均年龄(69±10)岁,非工作时间组205例(67.7%),工作时间组98例(32.3%)。非工作时间组与工作时间组术后90 d mRS评分差异无统计学意义(P=0.555),且发病至入院时间(P=0.823)、入院至置鞘时间(P=0.244)、置鞘至再通时间(P=0.847)差异均无统计学意义。在非工作时间组中,夜间组患者49例(23.9%),非夜间组患者156例(76.1%),两亚组的术后90 d mRS评分差异无统计学意义(P=0.812),但夜间组患者发病至入院时间显著延长[中位时间为284(180,371) min比220(150,290) min,Z=-2.438,P=0.015],而入院至置鞘时间、置鞘至再通时间差异均无统计学意义(P值分别为0.180、0.236)。结论 在接受EVT的前循环AIS-LVO患者中,并未发现“工作时间效应”对EVT流程及预后的影响,但夜间入院患者存在显著的院前延迟。Objective To investigate the “working-time effect” on the process and outcomes of early endovascular treatment(EVT) in patients with acute ischemic stroke with large vessel occlusion(AIS-LVO). Methods The patients with AIS-LVO of anterior circulation who received EVT in the advanced stroke center of the Yijishan Hospital of Wannan Medical College between February 2019 and March 2021 were retrospectively included. The enrolled patients were divided into on-hour group and off-hour group according to their arrival time. Subgroup analysis was performed for patients admitted at night(22∶00—07∶59) and non-night(08∶00—21∶59) in the off-hour group. The baseline characteristics, process time interval and 90-day modified Rankin scale(mRS) score after EVT were collected. The factors affecting diagnosis and treatment procedures and prognosis were analyzed. The primary outcome indicators were the mRS score at 90 days after EVT, and the secondary outcome indicators were recanalization of occluded vessel and symptomatic intracranial cerebral hemorrhage(sICH). Results A total of 303 patients(mean age: [69±10] years) were included in this study. There were 205 cases(67.7%) in the off-hour group and 98 cases(32.3%) in the on-hour group. There was no statistically significant difference in the 90-day mRS score between the off-hour group and the on-hour group(P=0.555), and there was no significant difference in time intervals between two groups, such as symptom onset to door time(P=0.823), door to puncture time(P=0.244) and puncture to reperfusion time(P=0.847). There were 49 cases(23.9%) in the night group and 156 cases(76.1%) in the non-night group. Similarly, there was no significant difference in 90-day mRS score between two groups(P=0.812). However, the time from symptom onset to door was significantly prolonged in the night group(median time: 284 [180,371] minutes vs. 220 [150,290] minutes, Z=-2.438, P=0.015), while there was no significant difference in the time from door to puncture and the time from punctur

关 键 词：卒中 前循环 大血管闭塞 血管内治疗 院前延迟 

分 类 号：R743.3[医药卫生—神经病学与精神病学]