院内急性缺血性卒中血管内介入治疗延误的影响因素分析

目的 分析院内急性缺血性卒中（acute ischemic stroke，AIS）患者血管内介入治疗延误的影响因素。方法 回顾性纳入2014年10月-2019年7月于南京医科大学第一附属医院住院期间发生AIS并接受血管内介入治疗的患者，根据发病至股动脉穿刺时间（onset-to-puncture time，OTP）是否超过120 min，将患者分为延误组和非延误组。收集两组患者相关临床资料，观察两组预后情况，良好预后定义为90 d mRS评分≤2分，采用多因素Logistic回归分析研究院内延误的影响因素。结果 共纳入53例院内卒中患者，平均年龄64.43±12.46岁，男性29例（54.72%）。中位OTP为150（115～200）min，其中延误组31例，非延误组22例。非延误组良好预后比例高于延误组（63.64%vs 35.48%，P =0.043）。多因素Logistic回归分析显示，发病后立即启动绿色通道（OR 0.061，95%CI0.007～0.532，P =0.011）及高危科室发病（OR 0.108，95%CI 0.014～0.821；P =0.031）与院内卒中血管内介入治疗延误呈独立负相关；而家属决策时间延长（OR 1.527，95%CI 1.114～2.094，P =0.008）与院内卒中血管内介入治疗延误呈独立正相关。结论 家属决策时间长是院内卒中血管内介入治疗延误的独立危险因素，发病后立即启动绿色通道及高危科室发病是院内卒中血管内介入治疗延误的独立保护因素。

Analysis of Influencing Factors for Delayed Endovascular Treatment of In-hospital Acute Ischemic Stroke

Objective The data of patients with acute ischemic stroke (AIS) who received endovasculartreatment were analyzed to investigate the influencing factors for the delay of endovasculartreatment for in-hospital stroke.Methods Patients with in-hospital onset AIS and received endovascular treatment from the FirstAffiliated Hospital with Nanjing Medical University between October 2014 and July 2019 wereretrospectively enrolled in this study, and the clinical data were collected. The patients were dividedinto two groups: delay group and non-delay group, according to whether the onset-to-puncture(OTP) time was more than 120 minutes. Good outcome was defined as a 90-day mRS score of 0 to2. Multivariate logistic regression analysis was used to investigate the factors associated with thedelay of endovascular treatment.Results A total of eligible 53 patients were included, with a mean age of 64.43±12.46 years and 29(54.72%) men, including 31 patients in delay group and 22 in no-delay group. The median (IQR) OTPtime was 150 (115-200) minutes. The proportion of patients with good outcome in non-delay groupwas higher than that in delay group (63.64% vs 35.48%, P =0.043). Multivariate logistic regressionanalysis showed that starting the fast track upon onset (OR 0.061, 95%CI 0.007-0.532, P =0.011) andstroke onset in the high-risk department (OR 0.108, 95%CI 0.014-0.821, P =0.031) were negatively correlated with the delay of endovascular treatment, while long decision-making time of the patient’srelatives (OR 1.527, 95%CI 1.114-2.094, P =0.008) was positively correlated with the delay.Conclusions Long decision-making time of the patient’s relatives was the independent risk factorfor delay of endovascular treatment of in-hospital stroke, while the high-risk departments andstarting fast track upon stroke onset were independent protective factors for delay of endovasculartreatment.