【摘要】 目的探究急性缺血性脑卒中(AIS)患者使用阿替普酶静脉溶栓院内延误因素。方法对经头部CT或磁共振成像确诊的86例AIS患者进行回顾性分析,患者全部接受阿替普酶静脉溶栓治疗,入院时美国国立卫生研究院卒中量表(NIHSS)评分为(12.29±5.77)分。据患者到达医院至使用阿替普酶静脉溶栓的时间(DNT),分为延误组(DNT> 60min,58例)和非延误组(DNT≤60 min,28例)。记录2组基线资料、临床资料,并进一步分析。结果非延误组与延误组120急救系统入院情况、决策者学历、患者家庭收入、入院NHISS评分、入院同型半胱氨酸值、发病到入院时长(ODT)、入院至专科医生接诊时长、患者及家属决策时长差异均具有统计学意义(P <0.05)。多因素Logistic回归分析显示入院NIHSS评分越高(OR=0.748,95%CI:[0.606,0.922],P=0.006)、ODT越长(OR=0.915,95%CI:[0.869,0.915],P=0.001)、患者及亲属决策时长越短(OR=1.258,95%CI:[1.047,1.512],P=0.014),发生溶栓治疗院内延误风险越低。结论 AIS患者院内延误情况严峻,制订严格的诊疗流程,培训专科医生的谈话技巧,加强健康宣教,提高患者对AIS的认识,对缩短院内延误时间具有重要意义。更多还原

【Abstract】 Objective To investigate into the factors of nosocomial delay in patients with acute ischemic stroke(AIS) treated with intravenous infusion of Alteplase. Methods We retrospectively studied the electronic medical records identifying consecutive 86 cases of patients of acute ischemic stroke, who were all treated by intravenous thrombolytic therapy. Their average score on the National Institutes of Health Stroke Scale(NIHSS) was(12.29±5.77) points at admission. According to door-to-needle time(DNT), patients were divided into either a delay group(DNT > 60 min, n = 58) or non-delayed group(DNT ≤ 60 min, n = 28). The patients’ baseline characteristics and clinical data were recorded in two groups. Results There were significant differences in the admission to the emergency center, the education degree of decision makers, annual family income,admission NHISS, admission homocysteine, onset-to-door time(ODT), the time from admission to specialistarrival, the duration of patient or family decision-maker between the two groups(P < 0.05). A multivariate Logistic regression analysis showed that the higher the NIHSS score(OR = 0.748, 95% CI: [0.606, 0.922],P = 0.006), the longer ODT(OR = 0.915, 95% CI: [0.869, 0.915], P = 0.001), the shorter of patients and relatives decision-making time(OR = 1.258, 95% CI: [1.047, 1.512], P = 0.014), the lower risk of hospital-delaying.Conclusion The condition of nosocomial delay with AIS patients is serious. It is imperative that nosocomial delay time be reduced, through a strict implementation of the treatment procedures, training physicians’ talking skills, strengthening health education and improving patients’ awareness of AIS.更多还原