不同工作时间段就诊对缺血性脑卒中患者静脉溶栓预后的影响

doi:10.3785/j.issn.1008-9292.2019.06.06

浙江大学学报（医学版）

2019, Vol. 48

Issue (3): 267-274 DOI: 10.3785/j.issn.1008-9292.2019.06.06

专题报道

不同工作时间段就诊对缺血性脑卒中患者静脉溶栓预后的影响

泮飞虎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

Effect of different working time on the prognosis of ischemic stroke patients undergoing intravenous thrombolysis

PAN Feihu¹(

),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, the Second Hospital of Jiaxing, 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: 比较不同工作时间段就诊并接受静脉溶栓治疗的缺血性脑卒中患者预后是否存在差异。方法: 回顾性分析浙江省71家医院2017年6月至2018年9月接受静脉溶栓治疗的3050例缺血性脑卒中患者的资料。比较周末组与非周末组、工作日夜间组与白天组、非常规工作时间组与常规工作时间组的基线资料及预后，采用二元Logistic回归分析法研究周末、工作日夜间、非常规工作时间是否为静脉溶栓患者预后的独立影响因素。结果: 周末组与非周末组、工作日夜间组与白天组、非常规工作时间组与常规工作时间组患者7 d病死率、3个月病死率和3个月预后良好的比例差异均无统计学意义（均P>0.05）。二元Logistic回归分析结果显示，周末、工作日夜间、非常规工作时间均不是缺血性脑卒中患者静脉溶栓治疗3个月预后的独立影响因素（均P>0.05）。结论: 浙江省周末与非周末、工作日夜间与白天、非常规工作时间与常规工作时间接受静脉溶栓的缺血性脑卒中患者的预后无差异。

关键词： 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 working time on the prognosis of patients with ischemic stroke undergoing intravenous thrombolysis. Methods: Clinical data of 3050 patients with ischemic stroke received intravenous thrombolysis from 71 hospitals in Zhejiang Province during June 2017 and September 2018 were retrospective analyzed. Whole day of Saturday and Sunday were defined as weekend; whole day of Monday to Friday were defined as weekdays; Monday to Friday 8:00-17:00 were defined as daytime of weekdays; Monday to Friday 17:01-07:59 on next day were defined as nights of weekdays; unconventional working time were defined as weekend and nights of weekdays. Good outcome was defined as mRS 0-2 at 3 months. Univariate analyses of baseline and prognostic variables in group of weekend and weekdays, nights of weekdays and daytime of weekdays, unconventional working time and daytime of weekdays were performed. Binary logistic regression was used to investigate whether weekend, nights of weekdays and unconventional working time were independent predicting factors of outcome after intravenous thrombolysis, respectively. Results: There was no difference in 7-day mortality, 3-month mortality and good outcome at 3-month between weekend group and weekdays group, nights of weekdays group and daytime of weekdays group, unconventional working time group and daytime of weekdays group (all P>0.05). Binary logistic regression results showed that weekends, nights of weekdays and unconventional working time were not independent predicting factors for outcome after intravenous thrombolysis (all P>0.05). Conclusion: The working time has not affected the outcomes of patients with ischemic stroke undergoing intravenous thrombolysis in studied hospitals of Zhejiang province.

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

收稿日期: 2018-12-20 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: p841024@163.com;lm99@zju.edu.cn

作者简介: 泮飞虎(1984-), 男, 硕士研究生, 主治医师, 主要从事神经病学研究; E-mail:p841024@163.com; https://orcid.org/0000-0002-6066-4517

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	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

引用本文:

泮飞虎, 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 . 不同工作时间段就诊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): 267-274.

PAN Feihu, 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 . Effect of different working time on the prognosis of ischemic stroke patients undergoing intravenous thrombolysis. J Zhejiang Univ (Med Sci), 2019, 48(3): 267-274.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.06.06 或 http://www.zjujournals.com/med/CN/Y2019/V48/I3/267

表 1 周末与非周末就诊的缺血性脑卒中患者的基线资料及预后比较

表 2 工作日白天与夜间就诊的缺血性脑卒中患者的基线资料及预后比较

表 3 非常规工作时间与常规工作时间就诊的缺血性脑卒中患者的基线资料及预后比较

表 4 缺血性脑卒中患者静脉溶栓治疗后3个月预后影响因素的单因素分析结果

表 5 周末和非周末就诊与缺血性脑卒中患者静脉溶栓治疗后3个月预后的相关性分析结果

表 6 工作日白天和夜间就诊与缺血性脑卒中患者静脉溶栓治疗后3个月预后的相关性分析结果

表 7 常规工作时间与非常规工作时间就诊与缺血性脑卒中患者静脉溶栓治疗后3个月预后的相关性分析结果

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