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J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (3): 260-266    DOI: 10.3785/j.issn.1008-9292.2019.06.05
    
Analysis of intravenous thrombolysis time and prognosis in patients with in-hospital stroke
ZHANG Congcong1(),LOU Min1,*(),CHEN Zhicai1,CHEN Hongfang2,XU Dongjuan3,WANG Zhimin4,HU Haifang5,WU Chenglong6,ZHANG Xiaoling7,MA Xiaodong8,WANG Yaxian9,HU Haitao1,Improving In-hospital Stroke Service Utilisation (MISSION) in Zhejiang Province
1. Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
2. Department of Neurology, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
3. Department of Neurology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
4. Department of Neurology, Taizhou First People's Hospital, Taizhou 318020, Zhejiang Province, China
5. Department of Neurology, the First People's Hospital of Xiaoshan District, Hangzhou 311201, China
6. Department of Neurology, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China
7. Department of Neurology, Jiaxing Second Hospital, Jiaxing 314000, Zhejiang Province, China
8. Department of Neurology, Haiyan People's Hospital, Haiyan 314300, Zhejiang Province, China
9. Department of Neurology, Huzhou Central Hospital, Huzhou 313003, Zhejiang Province, China
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Abstract  

Objective: To compare the time delay between in-hospital stroke and out-of-hospital stroke patients, and to explore the influence factors for the prognosis of in-hospital stroke patients treated by intravenous thrombolysis. Methods: Clinical data of 3050 patients with ischemic stroke who received intravenous thrombolysis in 71 hospitals in Zhejiang province from June 2017 to September 2018 were analyzed. Differences of time delay including door to imaging time (DIT), imaging to needle time (INT) and door to needle time (DNT) between in-hospital stroke (n=101) and out-of-hospital stroke (n=2949) were observed. The influencing factors for the outcome at 3 month after intravenous thrombolysis in patients with in-hospital stroke were analyzed using binary logistic regression analysis. Results: Patients with in-hospital stroke had longer DIT[53.5 (32.0-79.8) min vs. 20.0 (14.0-28.0) min, P < 0.01], longer IDT[47.5(27.3-64.0)min vs. 36.0(24.0-53.0)min, P < 0.01], and longer DNT[99.0 (70.5-140.5) min vs. 55.0 (41.0-74.0) min, P < 0.01], compared with patients with out-of-hospital stroke; patients in comprehensive stroke center had longer DIT[59.5(44.5-83.3) min vs. 37.5(16.5-63.5) min, P < 0.01], longer DNT[110.0(77.0-145.0) min vs. 88.0 (53.8-124.3) min, P < 0.05], but shorter INT[36.5(23.8-60.3)min vs. 53.5 (34.3-64.8) min, P < 0.05], compared with patients in primary stroke center. Age (OR=0.934, 95%CI: 0.882-0.989, P < 0.05) and baseline National Institute of Health Stroke Scale score (OR=0.912, 95%CI: 0.855-0.973, P < 0.01) were independent risk factors for prognosis of in-hospital stroke patients. Conclusion: In-hospital stroke had longer DIT and DNT than out-of-hospital stroke, which suggests that a more smooth thrombolysis process of in-hospital stroke should be established.



Key wordsInpatients      Stroke/diagnostic imaging      Stroke/therapy      Brain ischemia/therapy      Tissue plasminogen activator/therapeutic use      Thrombolytic therapy      Time factors      Prognosis     
Received: 04 February 2019      Published: 04 September 2019
CLC:  R743  
Corresponding Authors: LOU Min     E-mail: zhangcc00@126.com;lm99@zju.edu.cn
Cite this article:

ZHANG Congcong, LOU Min, CHEN Zhicai, CHEN Hongfang, XU Dongjuan, WANG Zhimin, HU Haifang, WU Chenglong, ZHANG Xiaoling, MA Xiaodong, WANG Yaxian, HU Haitao, Improving In-hospital Stroke Service Utilisation (MISSION) in Zhejiang Province . Analysis of intravenous thrombolysis time and prognosis in patients with in-hospital stroke. J Zhejiang Univ (Med Sci), 2019, 48(3): 260-266.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.06.05     OR     http://www.zjujournals.com/med/Y2019/V48/I3/260


医院内缺血性脑卒中患者静脉溶栓时间及预后分析

目的: 比较医院内卒中与医院外卒中患者静脉溶栓治疗时间的差异以及医院内卒中患者预后的影响因素。方法: 回顾性分析2017年6月至2018年9月在浙江省71家医院接受静脉溶栓治疗的3050例缺血性脑卒中患者的临床资料。比较医院内卒中(101例)与医院外卒中(2949例)患者溶栓治疗各时间点的差异,并采用二元Logistic回归分析法分析医院内卒中患者静脉溶栓治疗3个月预后的影响因素。结果: 医院内卒中患者比医院外卒中患者的入院至影像时间长[53.5(32.0,79.8)min vs 20.0(14.0,28.0)min,P < 0.01]、影像至溶栓时间长[47.5(27.3,64.0)min vs 36.0(24.0,53.0)min,P < 0.01]、入院至溶栓时间长[99.0(70.5,140.5)min vs 55.0(41.0,74.0)min,P < 0.01]。在医院内卒中患者中,高级卒中中心比初级卒中中心入院至影像时间更长[59.5(44.5,83.3)min vs 37.5(16.5,63.5)min,P < 0.01],入院至溶栓时间更长[110.0(77.0,145.0)min vs 88.0(53.8,124.3)min,P < 0.05],但影像至溶栓时间更短[36.5(23.8,60.3)min vs 53.5(34.3,64.8)min,P < 0.05]。二元Logistic回归分析结果显示,年龄(OR=0.934,95%CI:0.882~0.989,P < 0.05)和基线美国国立卫生研究院卒中量表(NIHSS)评分(OR=0.912,95%CI:0.855~0.973,P < 0.01)是医院内卒中患者静脉溶栓治疗3个月预后的独立影响因素。结论: 与医院外卒中相比,医院内卒中存在一定延误,未来需要建立更加流畅的医院内卒中溶栓流程。


关键词: 住院病人,  卒中/影像诊断,  卒中/治疗,  脑缺血/治疗,  组织型纤溶酶原激活物/治疗应用,  血栓溶解疗法,  时间因素,  预后 
[${\bar x}$±sn(%)或M(Q1Q3)]
组别 n 年龄(岁) 女性 吸烟史 高血压史 高脂血症史 糖尿病史 心房颤动史 卒中史 抗血小板药物使用史 抗凝药物使用史 基线NIHSS评分 溶栓前收缩压(mmHg) 溶栓前舒张压(mmHg) 溶栓前血糖(mmol/L) rt-PA溶栓 机械取栓 预后良好*
“—”无相关数据.*预后良好为3个月时改良Rankin量表评分2分及以下.NHISS:美国国立卫生研究院卒中量表;rt-PA:重组组织型纤溶酶原激活剂.1 mmHg=0.133 kPa.
医院内卒中组 101 71±11 42(41.6) 35(34.7) 69(68.3) 26(25.7) 19(18.8) 39(38.6) 17(16.8) 30(29.7) 3(3.0) 7(2, 14) 147(134, 163) 81(73, 89) 6.5(5.4, 8.0) 99(98.0) 13(12.9) 65(64.4)
医院外卒中组 2949 69±13 1149(39.0) 922(31.3) 1924(65.2) 461(15.6) 486(16.5) 756(25.6) 385(13.1) 439(14.9) 56(1.9) 7(3, 13) 155(140, 169) 85(76, 95) 6.9(6.0, 8.6) 2815(95.5) 235(8.0) 1920(65.1)
χ2/Z/t -1.093 0.282 0.521 0.408 7.439 0.384 8.535 1.217 16.475 0.591 -0.361 -2.77 -2.86 -2.969 1.507 3.076 0.024
P >0.05 >0.05 >0.05 >0.05 <0.05 >0.05 <0.01 >0.05 <0.01 >0.05 >0.05 <0.01 <0.01 <0.01 >0.05 >0.05 >0.05
Tab 1 Comparison of variables between patients with in-hospital stroke and out-of-hospital stroke
[M(Q1,Q3),min]
组别 n 起病至入院时间 入院至影像时间 影像至溶栓时间 入院至溶栓时间 起病至影像时间 起病至溶栓时间
与医院外卒中组比较,* *P < 0.01;与同一级别卒中中心医院外卒中组比较,#P < 0.05,##P < 0.01;与初级卒中中心医院内卒中组比较,P < 0.05,△△P < 0.01.
医院内卒中组 101 0(0,0)** 53.5(32.0, 79.8)** 47.5(27.3, 64.0)** 99.0(70.5, 140.5)** 53.5(32.0, 79.8)** 99.0(70.5, 140.5)**
  高级卒中中心 47 0(0, 0)## 59.5(44.5, 83.3)##△△ 36.5(23.8, 60.3)##△ 110.0(77.0, 145.0)## 59.5(44.5, 83.3)## 110.0(77.0, 145.0)##
  初级卒中中心 54 0(0, 0)## 37.5(16.5, 63.5)## 53.5(34.3, 64.8)# 88.0(53.8, 124.3)## 37.5(16.5, 63.5)## 88.0(53.8, 124.3)##
医院外卒中组 2949 100.0(60.0, 152.0) 20.0(14.0, 28.0) 36.0(24.0, 53.0) 55.0(41.0, 74.0) 119.0(79.0, 169.0) 167.0(123.0, 218.0)
  高级卒中中心 1299 113.0(65.0, 165.0) 23.0(17.0, 34.0) 29.0(20.0, 44.0) 53.0(41.0, 74.0) 135.0(87.3, 186.0) 180.0(129.0, 228.0)
  初级卒中中心 1650 91.0(60.0, 140.0) 17.0(12.0, 24.0) 40.0(28.0, 57.0) 56.0(42.0, 73.0) 107.0(73.0, 151.0) 160.0(120.0, 205.0)
Tab 2 Comparison of time delay between patients with in-hospital stroke and out-hospital stroke
[${\bar x}$±sn(%)或M(Q1Q3)]
影响因素 预后良好(n=65) 预后不良(n=36) χ2/Z/t P
“—”无相关数据.预后良好定义为3个月时mRS评分2分及以下.NHISS:美国国立卫生研究院卒中量表;rt-PA:重组组织型纤溶酶原激活剂.1 mmHg=0.133 kPa.
年龄(岁) 67±11 76±8 -4.334 <0.01
女性 22(33.8) 20(55.6) 4.495 <0.05
吸烟史 28(43.1) 7(19.4) 5.714 <0.05
高血压史 43(66.2) 26(77.2) 0.394 >0.05
高脂血症史 17(26.2) 9(25.0) 0.016 >0.05
糖尿病史 9(13.8) 10(27.8) 2.944 >0.05
心房颤动史 22(33.8) 17(47.2) 1.749 >0.05
卒中史 8(12.3) 9(25.0) 2.666 >0.05
抗血小板药物使用史 14(21.2) 16(44.4) 5.822 <0.05
抗凝药物使用史 1(1.5) 2(5.6) 1.297 >0.05
基线NHISS评分 7.3±7.4 12.4±8.0 -3.250 <0.01
溶栓前收缩压(mmHg) 144±22 153±22 -1.901 >0.05
溶栓前舒张压(mmHg) 80±12 84±12 -1.377 >0.05
溶栓前血糖(mmol/L) 6.6±2.5 7.0±2.0 -0.160 >0.05
入院至影像时间(min) 52.5(32.0, 78.8) 55.0(30.5, 84.0) 0.172 >0.05
影像至溶栓时间(min) 45.0(24.3, 62.5) 48.5(31.3, 64.0) 0.221 >0.05
入院至溶栓时间(min) 90.0(57.0, 143.0) 100.5(76.3, 138.5) 0.546 >0.05
起病至影像时间(min) 52.5(32.0, 78.8) 55.0(30.5, 84.0) 0.155 >0.05
起病至溶栓时间(min) 90.0(57.0, 143.0) 100.5(76.3, 138.5) 0.546 >0.05
rt-PA溶栓 64(98.5) 35(97.2) 0.183 >0.05
机械取栓 5(7.7) 8(22.2) 4.362 >0.05
高级卒中中心 30(46.2) 17(47.2) 0.011 >0.05
Tab 3 Comparison of baseline characteristics between good prognosis group and poor prognosis group in patients with in-hospital stroke
变量 OR 95%CI P
NHISS:美国国立卫生研究院卒中量表.
年龄 0.934 0.882~0.989 <0.05
女性 0.444 0.140~1.406 >0.05
吸烟史 1.996 0.534~7.453 >0.05
抗血小板药物使用史 0.576 0.193~1.721 >0.05
基线NIHSS评分 0.912 0.855~0.973 <0.01
Tab 4 Binary logistic regression analysis of prognosis at 3-month in patients with in-hospital stroke
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