区域内转诊对前循环大血管闭塞急性缺血性脑卒中患者血管内治疗预后的影响  

Impact of regional referral on prognosis of patients with acute ischemic stroke with large vessel occlusion of anterior circulation after endovascular treatment

作　　者：沈芳 江薇[2] 沈红健[1] 朱宣[1] 花伟龙 邢鹏飞[1] 张磊[1] 李子付[1] 杨鹏飞[1] 张永巍[1] 刘建民[1] SHEN Fang;JIANG Wei;SHEN Hongjian;ZHU Xuan;HUA Weilong;XING Pengfei;ZHANG Lei;LI Zifu;YANG Pengfei;ZHANG Yongwei;LIU Jianmin(Neurovascular Center,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Radiology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院脑血管病中心,上海200433 [2]海军军医大学(第二军医大学)第一附属医院放射诊断科,上海200433

出　　处：《海军军医大学学报》2023年第9期1038-1044,共7页Academic Journal of Naval Medical University

基　　金：国家自然科学基金(82071278);上海市浦江人才计划(2019PJD051);海军军医大学(第二军医大学)校级课题(2022QN049).

摘　　要：目的探讨不同就诊方式对前循环大血管闭塞急性缺血性脑卒中(AIS-LVO)患者血管内治疗预后的影响。方法回顾性连续纳入2019年1月至2021年6月在海军军医大学(第二军医大学)第一附属医院脑血管病中心接受血管内治疗的前循环AIS-LVO患者,根据其就诊方式分为直接就诊组和转诊组,直接就诊组患者通过120急救系统或其他交通工具直接至我院急诊就诊,转诊组患者由其他医院通过120急救系统转诊至我院急诊就诊。分析两组患者的基线资料、就诊流程及血管内治疗术后结局指标。结果共有239例患者纳入本研究,其中直接就诊组129例,转诊组110例。与直接就诊组相比,转诊组就诊前预警患者的比例更高、基线美国国立卫生研究院卒中量表(NIHSS)评分更高、核心梗死体积更大、Alberta脑卒中计划早期计算机断层扫描评分(ASPECTS)更低,差异均有统计学意义(P均<0.01);转诊组患者发病至入院时间、发病至穿刺时间、发病至血管再通时间均较直接就诊组更长[258(175,373)min vs 94(60,176)min,354(284,494)min vs 225(162,318)min,417(340,577)min vs 277(205,424)min;P均<0.001],而入院至穿刺时间、入院至血管再通时间与直接就诊组相比更短[94(75,127)min vs 103(86,139)min,151(115,193)min vs 162(133,217)min;P均<0.05]。转诊组90 d良好预后率为49.1%(54/110),低于直接就诊组的63.6%(82/129)(P=0.024),同时其症状性颅内出血患者比例和死亡率高于直接就诊组[14.5%(16/110)vs 6.2%(8/129),20.0%(22/110)vs 10.1%(13/129);P均<0.05]。结论接受血管内治疗的前循环AIS-LVO患者中,转诊组患者卒中病情更严重,血管内治疗后症状性颅内出血发生率更高,死亡率更高,90 d良好预后率更低。Objective To explore the impact of different treatment methods on the prognosis of patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)of anterior circulation after endovascular treatment.Methods Patients with AIS-LVO of anterior circulation who received endovascular treatment in Neurovascular Center,The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.2019 to Jun.2021 were retrospectively enrolled.The patients were divided into directly admitted group and transfer group based on their treatment methods.The patients in the directly admitted group were directly admitted to our emergency department through the 120 emergency system or other transportation,while the patients in the transfer group were transferred to our emergency department through the 120 emergency system from other hospitals.The baseline data,treatment process and postoperative outcome indicators after endovascular treatment were analyzed between the 2 groups.Results A total of 239 patients were enrolled,including 129 patients in the directly admitted group and 110 patients in the transfer group.Compared with the directly admitted group,the transfer group had a higher proportion of pre-hospital warning,a higher baseline National Institute of Health stroke scale score,a larger core infarction volume,and a lower Alberta Stroke Program early computed tomography score(all P<0.01).The onset-to-door time,onset-to-puncture time and onset-to-recanalization time in the transfer group were longer than those in the directly admitted group(258[175,373]min vs 94[60,176]min,354[284,494]min vs 225[162,318]min,417[340,577]min vs 277[205,424]min;all P<0.001),while the transfer group had shorter door-topuncture time and door-to-recanalization time(94[75,127]min vs 103[86,139]min,151[115,193]min vs 162[133,217]min;both P<0.05).The proportion of 90-d good prognosis in the transfer group was only 49.1%(54/110),significantly lower than 63.6%(82/129)in the directly admitted group(P=0.024).Meanwhile the

关 键 词：大血管闭塞急性缺血性脑卒中 血管内治疗 直接就诊 区域内转诊 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]