治疗时间提前可改善缺血性脑卒中患者再灌注治疗的预后

doi:10.3785/j.issn.1008-9292.2019.06.03

浙江大学学报（医学版）

2019, Vol. 48

Issue (3): 247-253 DOI: 10.3785/j.issn.1008-9292.2019.06.03

专题报道

治疗时间提前可改善缺血性脑卒中患者再灌注治疗的预后

陈红芳¹(

),龚筱弦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²,楼敏²,陈智才^2,*(

),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. 浙江大学金华医院金华市中心医院神经内科, 浙江金华 321000
2. 浙江大学医学院附属第二医院神经内科, 浙江杭州 310009
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

Advanced treatment time improves outcomes of patients with ischemic stroke undergoing reperfusion therapy

CHEN Hongfang¹(

),GONG Xiaoxian²,XU Dongjuan³,WANG Zhimin⁴,HU Haifang⁵,WU Chenglong⁶,ZHANG Xiaoling⁷,MA Xiaodong⁸,WANG Yaxian⁹,HU Haitao²,LOU Min²,CHEN Zhicai^2,*(

),Improving In-hospital Stroke Service Utilisation (MISSION) in Zhejiang Province

1. Department of Neurology, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
2. Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, 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: 探究缺血性脑卒中患者再灌注治疗时间与预后的关系。方法: 纳入2017年6月至2018年9月在浙江省卒中急救平台上报的71家医院中接受单纯静脉溶栓或者桥接动脉取栓治疗的缺血性脑卒中患者3229例。3个月改良Rankin量表（mRS）2分及以下为预后良好。采用二元Logistic回归分析法研究入院至溶栓时间（DNT）、入院至再灌注时间（DRT）与患者治疗后3个月预后的关系。结果: DNT和DRT分别是单纯静脉溶栓治疗、静脉溶栓桥接动脉取栓治疗患者预后的独立影响因素（OR=0.994，95%CI：0.991~0.997，P < 0.01；OR=0.989，95%CI：0.983~0.995，P < 0.01）。对于单纯静脉溶栓治疗的患者，DNT每减少1 h，3个月预后良好的比例提高约4.7%；而对于静脉溶栓桥接动脉取栓治疗的患者，DRT每减少1 h，3个月预后良好的比例提高约11.4%。结论: 缩短时间窗内缺血性脑卒中患者的DNT或DRT，可以不同程度地提高患者再灌注治疗3个月预后良好的比例。

关键词： 卒中/治疗; 脑缺血/治疗; 纤溶酶原激活剂/治疗应用; 血栓溶解疗法; 再灌注; 血管内治疗; 时间因素; 预后

Abstract:

Objective: To investigate the effect of treatment time on the outcome of patients with ischemic stroke undergoing reperfusion therapy. Methods: The clinical data of 3229 ischemic stroke patients who received intravenous thrombolysis with or without arterial thrombolysis from 71 hospitals in Zhejiang province from June 2017 to September 2018 were retrospectively reviewed. The good outcome was defined as modified Rankin Scale (mRS) ≤ 2. Binary logistic regression analysis was used to investigate the association of door to needle time (DNT), or door to reperfusion time (DRT) with the outcomes in patients treated by intravenous thrombolysis or bridging arterial thrombolysis, respectively. Results: Binary logistic regression showed that DNT (OR=0.994, 95%CI:0.991-0.997, P < 0.01) or DRT (OR=0.989, 95%CI:0.983-0.995, P < 0.01) were independently associated with good outcomes, respectively. Every hour decreases in DNT resulted in a 4.7%increased probability of functional independence (mRS 0-2) in patients treated by intravenous thrombolysis; Every hour decreases in DRT was associated with a 11.4%increased probability of functional independence in patients treated by intravenous thrombolysis with arterial thrombolysis. Conclusion: Good outcomes are associated with lower DNT in ischemic stroke patients treated by intravenous thrombolysis or lower DRT in patients treated by intravenous thrombolysis bridging arterial thrombolysis.

Key words: Stroke/therapy Brain ischemia/therapy Plasminogen activators/therapeutic use Thrombolytic therapy Reperfusion Endovascular treatment Time factors Prognosis

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);浙江省公益性技术应用研究计划(2016C33228);浙江省医药卫生科技计划(2015KYB417)

通讯作者: 陈智才 E-mail: jhchf894@163.com;chenzhicai@zju.edu.cn

作者简介: 陈红芳(1967-), 女, 硕士, 主任医师, 主要从事神经病学研究; E-mail:jhchf894@163.com; https://orcid.org/0000-0002-0706-9559

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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:

陈红芳, 龚筱弦, 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, 陈智才, 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 . 治疗时间提前可改善缺血性脑卒中患者再灌注治疗的预后[J]. 浙江大学学报（医学版）, 2019, 48(3): 247-253.

CHEN Hongfang, GONG Xiaoxian, XU Dongjuan, WANG Zhimin, HU Haifang, WU Chenglong, ZHANG Xiaoling, MA Xiaodong, WANG Yaxian, HU Haitao, LOU Min, CHEN Zhicai, Improving In-hospital Stroke Service Utilisation (MISSION) in Zhejiang Province . Advanced treatment time improves outcomes of patients with ischemic stroke undergoing reperfusion therapy. J Zhejiang Univ (Med Sci), 2019, 48(3): 247-253.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.06.03 或 http://www.zjujournals.com/med/CN/Y2019/V48/I3/247

表 1 缺血性脑卒中患者再灌注治疗预后影响因素的单因素分析结果

表 2 单纯静脉溶栓的缺血性脑卒中患者预后良好影响因素的二元Logistic回归分析结果

表 3 静脉溶栓桥接动脉取栓的缺血性脑卒中患者预后良好影响因素的二元Logistic回归分析结果

图 1 单纯静脉溶栓的缺血性脑卒中患者3个月预后良好比例与入院至溶栓时间的二元Logistic回归分析结果

图 2 静脉溶栓桥接动脉取栓的缺血性脑卒中患者3个月预后良好比例与入院至再灌注时间的二元Logistic回归分析结果

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