多中心老年急性缺血性脑卒中静脉溶栓占比及院前延迟原因分析  

Proportion of intravenous thrombolysis in elderly patients with acute ischemic stroke and causes of prehospital delay:a multicenter study

作　　者：王艳淑 王则托 贾存玮 牛建平 吕云利 刘献增 Wang Yanshu;Wang Zetuo;Jia Cunwei;Niu Jianping;LüYunli;Liu Xianzeng(Department of Neurology,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院神经内科,102206 [2]厦门医学院附属第二医院神经内科 [3]解放军联勤保障部队第九四〇医院神经内科

出　　处：《中华老年心脑血管病杂志》2023年第3期272-275,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的调查多中心老年急性缺血性脑卒中(AIS)静脉溶栓及院前延迟的情况,并分析影响老年AIS院前延迟的就医行为,为老年AIS的科普和管理决策提供依据。方法回顾性分析2018年1月1日至2022年8月31日来自3家卒中中心住院的老年AIS患者1867例,记录患者年龄、性别、发病至就诊时间、医疗费用类型、来院方式、独居、转诊、发病地点、危险因素、发病前改良的Rankin量表、发病时美国国立卫生研究院卒中量表(NIHSS)、脑卒中意识、新型冠状病毒肺炎影响等。根据患者发病至就诊时间是否在4.5 h内分为及时组447例和延迟组1420例。统计老年AIS静脉溶栓率,采用多因素logistic分析评估院前延迟的影响因素。结果本研究431例(23.1%)使用了静脉溶栓治疗;而在未使用静脉溶栓的原因中,院前延迟1272例(88.6%),占比最大。2组使用急救服务系统、独居、转诊、心房颤动、NIHSS评分、缺乏脑卒中意识比例比较有统计学差异(P<0.05,P<0.01)。多因素logistic回归分析显示,发病时NIHSS评分高(OR=0.876,95%CI:-0.192~-0.073)、独居(OR=23.558,95%CI:2.166~4.153)、转诊(OR=2.913,95%CI:0.417~1.721)、缺乏脑卒中意识(OR=84.562,95%CI:4.057~4.818)是院前延误的独立影响因素(P<0.01)。结论老年AIS患者静脉溶栓率不高,而院前延迟是提高静脉溶栓率的主要障碍。减少转诊、提高脑卒中意识等可能有助于缩短院前延迟的时间,增加AIS静脉溶栓比例。Objective To investigate the conditions of intravenous thrombolysis and prehospital delay in elderly patients with AIS in multicenter and analyze the factors influencing their prehospital delay in order to provide references for the science popularization and management decision-making of elderly AIS patients.Methods A retrospective study was carried out on 1867 elderly AIS patients hospitalized in 3 stroke centers from January 1,2018 to August 31,2022.Age,gender,time from onset to treatment,type of medical expenses,way of admission,living alone or not,referral,location of onset,risk factors,preonset mRS score,NIHSS score at onset,stroke awareness,COVID-19 impact,etc were recorded.According to whether the time from onset to visit was within 4.5 h,the patients were divided into timely group(n=447)and delayed group(n=1420).The rate of intravenous thrombolysis was counted.Multivariate analyses was used to analyze the influencing factors of prehospital delay.Results Of the 1867 elderly AIS patients,431(23.1%)received intravenous thrombolysis.Among the reasons for not using intravenous thrombolysis,prehospital delay(88.6%)accounted for the largest proportion.There were statistically significant differences between the two groups in the use of emergency medical services,living alone,referral,atrial fibrillation,NIHSS score at onset,and lack of stroke awareness(P<0.05,P<0.01).Logistic regression analysis showed that living alone(OR=23.558,95%CI:2.166-4.153),referral(OR=2.913,95%CI:0.417-1.721),high NIHSS score at onset(OR=0.876,95%CI:-0.192--0.073),and lack of stroke awareness(OR=84.562,95%CI:4.057-4.818)were independent factors of prehospital delay(P<0.01).Conclusion The rate of intravenous thrombolysis is not high in the AIS elderly,and prehospital delay is the main obstacle to improve the rate.Reducing referral and improving stroke awareness may help to shorten the time of prehospital delay and increase the patients receiving intravenous thrombolysis.

关 键 词：卒中 纤维蛋白溶解药 回顾性研究 院前延迟 

分 类 号：R743.3[医药卫生—神经病学与精神病学]