多中心基层医院急性缺血性卒中静脉溶栓影响因素分析

目的 探讨基层医院急性缺血性卒中重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator，rt-PA）静脉溶栓院内延迟的影响因素。 方法 收集就诊于台州地区9家基层医院4.5 h内接受rt-PA静脉溶栓治疗的急性缺血性卒中患者的 资料，统计院内延迟时间（门-针时间）（door -to-needle time，DNT）以及各控制因素的平均时间，根据 DNT平均值及DNT是否超过60 min进行分组，并分析影响DNT的相关因素。 结果 共入组28例患者，平均DNT为（79.50±26.97）min。DNT≤79.50 min组相较于DNT＞79.50 min 组，到院至卒中团队接诊时间（P＝0.007）、到院至谈话时间（P＜0.001）、到院至到达病房时间（P ＜0.001）、到院至得到化验结果时间（P＜0.001）以及完成计算机断层扫描（computed tomography，CT） 至用药时间较短（P＜0.001），高血压病（P＝0.049）、高脂血症（P＝0.007）及心房颤动病史（P＝0.022） 比例较小，收缩压相对较低（P＝0.021）。比较DNT≤60 min及DNT＞60 min组，前者到院至出发行CT检 查时间（P＝0.025）、到院至完成CT时间（P =0.001）、到院至谈话时间（P＜0.001）、到院至到达病房 时间（P＜0.001）、到院至得到化验结果时间（P＝0.009）以及完成CT至用药时间较短（P <0.001），血 糖水平相对较低（P =0.001），糖尿病（P＝0.001）及高脂血症病史（P＝0.030）比例较小。Logi sti c回 归分析显示，到院至完成CT检查时间比值比（odds ratio，OR）0.954，95％可信区间（confidence interval， CI）0.917～0.992，P =0.005）]、到院至谈话时间（OR 0.501，95％CI 0.320～0.781，P =0.003）、到院至 到达病房时间（OR 0.925，95％CI 0.886～0.970，P =0.010）以及完成CT至用药时间（OR 0.796，95％ CI 0.620～0.982，P =0.005）、到院至得到化验结果时间（OR 0.496，95％CI 0.312～0.804，P =0.037） 的延长、血糖的升高（OR 0.610，95％CI 0.281～0.969，P =0.017）是DNT≤60 min的阻碍因素。 结论 基层医院到院至完成CT检查时间、到院至谈话时间、到院至到达病房时间、到院至得到化验 结果时间、完成CT至用药时间以及血糖是影响缺血性卒中患者静脉溶栓治疗DNT的主要因素。

Preliminary Analysis of Influencial Factors of Intravenous Thrombolysis in Acute Ischemic Stroke of Multi-center Primary Hospital

Objective To investigate the influential factors for in-hospital delay of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke in multi-center primary hospital. Methods Patients in nine basic-level hospitals in Taizhou treated with rt-PA intravenous thrombolytic within 4.5 hours after stroke onset were collected into this study. Based on the door-to-needle time (DNT) on average and the DNT less or more than 60 minutes, patients were divided into two groups, and then the independent factors associated with the DNT was analyzed. Results The mean DNT of 28 patients is (79.50±26.97 min). As compared to the DNT>79.50 minutes group, delay in admission to the stroke team acception (P=0.007), to the conversation (P<0.001), to
reaching the wards (P<0.001), and to CT examination (P<0.001) were shorter, history of hypertension (P=0.049), hyperlipidemia (P=0.007), and atrial ifbrillation were smaller (P=0.022). And as compared to the DNT>60 min group, delay in admission to CT examination (P=0.025), to the conversation (P<0.001), to reaching the wards (P<0.001), and delay in CT examination to drug using (P<0.001), to the laboratory results were shorter (P=0.009), blood glucose was relatively lower (P=0.001), history of diabetes (P=0.001) and hyperlipidemia (P=0.030) were smaller. Logistic regression analysis showed that delay in admission to CT examination (OR=0.954, 95%CI 0.917~0.992,P=0.005), to the conversation (OR=0.501, 95%CI 0.320~0.781,P=0.003), to reaching the wards (OR=0.925, 95%CI 0.886~0.970,P=0.010) and delay in CT examination to drug using (OR=0.796, 95%CI 0.620~0.982, P=0.005), to the laboratory results (OR=0.496, 95%CI 0.312~0.804,P=0.037), and blood glucose (OR=0.610, 95%CI 0.281~0.969,P=0.017) lead to longer DNT. Conclusion The time between admission to CT examination, to the conversation, to reaching the wards and CT examination to drug using, to the laboratory results, and also the blood glucose are the main factors inlfuencing the DNT.