院前急救医疗服务对缺血性脑卒中患者静脉溶栓预后的影响

doi:10.3785/j.issn.1008-9292.2019.06.02

浙江大学学报（医学版）

2019, Vol. 48

Issue (3): 241-246 DOI: 10.3785/j.issn.1008-9292.2019.06.02

专题报道

院前急救医疗服务对缺血性脑卒中患者静脉溶栓预后的影响

钟晚思¹(

),陈智才^1,*(

),陈红芳²,徐冬娟³,王志敏⁴,胡海芳⁵,吴承龙⁶,张晓玲⁷,马小董⁸,王亚仙⁹,胡海涛¹,楼敏¹,浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组

1. 浙江大学医学院附属第二医院神经内科, 浙江杭州 310009
2. 浙江大学金华医院金华市中心医院神经内科, 浙江金华 321000
3. 东阳市人民医院神经内科, 浙江东阳 322100
4. 台州市第一人民医院神经内科, 浙江台州 318020
5. 杭州市萧山区第一人民医院神经内科, 浙江杭州 311201
6. 绍兴市人民医院神经内科, 浙江绍兴 312000
7. 嘉兴市第二医院神经内科, 浙江嘉兴 314000
8. 海盐县人民医院神经内科, 浙江海盐 314300
9. 湖州市中心医院神经内科, 浙江湖州 313003

Effects of emergency medical service on prognosis of ischemic stroke patients treated with intravenous thrombolysis

ZHONG Wansi¹(

),CHEN Zhicai^1,*(

),CHEN Hongfang²,XU Dongjuan³,WANG Zhimin⁴,HU Haifang⁵,WU Chenglong⁶,ZHANG Xiaoling⁷,MA Xiaodong⁸,WANG Yaxian⁹,HU Haitao¹,LOU Min¹,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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摘要：

目的: 分析浙江省院前急救医疗服务（EMS）是否与缺血性脑卒中患者静脉溶栓的预后相关。方法: 回顾性分析浙江省70家医院中行静脉溶栓治疗的2123例缺血性脑卒中患者的临床资料，根据是否通过急救车途径到达医院急诊室分为EMS组（808例）和非EMS组（1315例）。3个月改良Rankin量表（mRS）评分2分及以下定义为预后良好。比较EMS组和非EMS组起病至溶栓时间（ONT）、起病至入院时间（ODT）、入院至溶栓时间（DNT）和预后的差异，并采用二元Logistic回归分析研究患者3个月预后的影响因素。结果: 与非EMS组比较，EMS组年龄更大、病情更重、合并心房颤动病史比例更高（均P < 0.05），两组ONT、ODT、DNT差异均无统计学意义（均P>0.05）。二元Logistic回归模型分析结果显示，EMS与患者3个月预后良好无相关性（OR=0.856，95%CI：0.664~1.103，P>0.05）。结论: 目前EMS途径尚不能缩短缺血性脑卒中静脉溶栓患者的ONT等，也未能改变其3个月预后。

关键词： 急救医疗服务; 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; 回顾性研究

Abstract:

Objective: To investigate the effect of emergency medical service (EMS) on the prognosis of ischemic stroke patients treated with intravenous thrombolysis. Methods: Clinical data of 2123 ischemic stroke patients treated with intravenous thrombolysis in 70 hospitals in Zhejiang province were retrospectively analyzed. There were 808 patients sent to the hospital by ambulance (EMS group) and 1315 patients by other transportations (non-EMS group). Good outcome was defined as modified Rankin Scale (mRS) ≤ 2 at 3-month. The onset to needle time (ONT), onset to door time (ODT), door to needle time (DNT) and outcome were compared between EMS group and non-EMS group. Binary logistic regression was used to explore the influencing factors for the outcome at 3-month. Results: Compared with the non-EMS group, patients in the EMS group were older, with higher baseline National Institute of Health Sroke Scale (NIHSS) score, and had a higher proportion of atrial fibrillation (all P < 0.05), but there were no significant differences in ONT, ODT and DNT between two groups (all P>0.05). Binary logistic regression showed that EMS was not independently associated with good outcome (OR=0.856, 95%CI:0.664-1.103, P>0.05). Conclusion: EMS had not improve the outcome of patients receiving intravenous thrombolysis in Zhejiang province.

Key words: Emergency medical services Stroke/therapy Brain ischemia/therapy Tissue plasminogen activator/therapeutic use Thrombolytic therapy Time factors Prognosis Retrospective studies

收稿日期: 2019-02-04 出版日期: 2019-09-04

CLC:

R743

基金资助: 浙江省重点研发计划(2018C04011);国家自然科学基金(81622017);国家重点研发计划(2016YFC1301503);中国中青年研究基金（"V.G"项目）(2017-CCA-VG-004)

通讯作者: 陈智才 E-mail: 21718233@zju.edu.cn;chenzhicai@zju.edu.cn

作者简介: 钟晚思(1994-), 女, 硕士研究生, 主要从事神经病学研究; E-mail:21718233@zju.edu.cn; https://orcid.org/0000-0002-4775-7778

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	浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组

引用本文:

钟晚思, 陈智才, 陈红芳, 徐冬娟, 王志敏, 胡海芳, 吴承龙, 张晓玲, 马小董, 王亚仙, 胡海涛, 楼敏, 浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组 . 院前急救医疗服务对缺血性脑卒中患者静脉溶栓预后的影响[J]. 浙江大学学报（医学版）, 2019, 48(3): 241-246.

ZHONG Wansi, CHEN Zhicai, CHEN Hongfang, XU Dongjuan, WANG Zhimin, HU Haifang, WU Chenglong, ZHANG Xiaoling, MA Xiaodong, WANG Yaxian, HU Haitao, LOU Min, Improving In-hospital Stroke Service Utilisation (MISSION) in Zhejiang Province . Effects of emergency medical service on prognosis of ischemic stroke patients treated with intravenous thrombolysis. J Zhejiang Univ (Med Sci), 2019, 48(3): 241-246.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.06.02 或 http://www.zjujournals.com/med/CN/Y2019/V48/I3/241

表 1 EMS组与非EMS组基线资料比较

表 2 EMS组与非EMS组溶栓治疗各时间段比较

表 3 静脉溶栓治疗后3个月预后良好与预后不良组基线及治疗情况比较

表 4 静脉溶栓治疗患者3个月预后良好的二元Logistic回归分析结果

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