医院内缺血性脑卒中患者静脉溶栓时间及预后分析

doi:10.3785/j.issn.1008-9292.2019.06.05

浙江大学学报（医学版）

2019, Vol. 48

Issue (3): 260-266 DOI: 10.3785/j.issn.1008-9292.2019.06.05

专题报道

医院内缺血性脑卒中患者静脉溶栓时间及预后分析

张聪聪¹(

),楼敏^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,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

Analysis of intravenous thrombolysis time and prognosis in patients with in-hospital stroke

ZHANG Congcong¹(

),LOU Min^1,*(

),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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摘要：

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

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 words: Inpatients Stroke/diagnostic imaging Stroke/therapy Brain ischemia/therapy Tissue plasminogen activator/therapeutic use Thrombolytic therapy 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);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: 楼敏 E-mail: zhangcc00@126.com;lm99@zju.edu.cn

作者简介: 张聪聪(1988-), 女, 硕士研究生, 主治医师, 主要从事神经病学研究; E-mail:zhangcc00@126.com; https://orcid.org/0000-0002-5922-5058

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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:

张聪聪, 楼敏, 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, 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 . 医院内缺血性脑卒中患者静脉溶栓时间及预后分析[J]. 浙江大学学报（医学版）, 2019, 48(3): 260-266.

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.

链接本文:

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

表 1 医院内卒中与医院外卒中患者一般情况、基线特征及预后比较

表 2 医院内卒中与医院外卒中患者溶栓治疗各时间比较

表 3 医院内卒中患者静脉溶栓后3个月预后影响因素的单因素分析结果

表 4 医院内卒中患者静脉溶栓后3个月预后的二元Logistic回归分析结果

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