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浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (3): 241-246    DOI: 10.3785/j.issn.1008-9292.2019.06.02
    
Effects of emergency medical service on prognosis of ischemic stroke patients treated with intravenous thrombolysis
ZHONG Wansi1(),CHEN Zhicai1,*(),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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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     
Received: 04 February 2019      Published: 04 September 2019
CLC:  R743  
Corresponding Authors: CHEN Zhicai     E-mail: 21718233@zju.edu.cn;chenzhicai@zju.edu.cn
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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
Cite this article:

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.

URL:

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


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

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 
[${\bar x}$±s或n(%)或M(Q1, Q3)]
组别 n 年龄(岁) 女性 基线NIHSS评分 溶栓前收缩压(mmHg) 溶栓前舒张压(mmHg) 基线血糖(mmol/L) 吸烟史 高血压史 糖尿病史 心房颤动史 卒中史 抗凝药物使用史 抗血小板药物使用史 动脉取栓治疗 rt-PA溶栓
“—”无相关数据.EMS：院前急救医疗服务；NIHSS：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.
EMS组 808 70±13 300(37.1) 9(4, 17) 156(141, 169) 86(76, 95) 0.38(0.33, 0.48) 199(26.7) 510(63.1) 113(14.0) 225(27.8) 96(11.9) 11(1.4) 113(14.0) 76(9.5) 777(96.2)
非EMS组 1315 68±13 517(39.3) 4(2, 10) 154(140, 68) 86(77, 95) 0.38(0.33, 0.47) 330(27.9) 848(64.5) 207(15.7) 223(17.0) 156(11.9) 29(2.2) 207(15.7) 46(3.5) 1212(96.2)
t/χ2/Z值 — 2.877 1.011 -13.122 -0.839 -0.385 -1.376 0.329 0.406 1.206 35.638 0.001 1.874 0.023 32.306 13.515
P值 — ＜0.01 ＞0.05 ＜0.01 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＜0.01 ＞0.05 ＞0.05 ＞0.05 ＜0.01 ＜0.01
Tab 1 Baseline characteristics of patients transferred by emergency medical service (EMS) and non-EMS
[min, M(Q1, Q3)]
组别 n 起病至入院时间 起病至溶栓时间 入院至溶栓时间
EMS组 808 90(59, 140) 160(120, 210) 55(42, 73)
非EMS组 1315 91(60, 140) 162(120, 212) 54(42, 71)
Z值 — -0.787 -0.965 -0.885
P值 — ＞0.05 ＞0.05 ＞0.05
“—”无相关数据.EMS：院前急救医疗服务.
Tab 2 Univariate comparisons of time among patients transferred by emergency medical service (EMS) and non-EMS
[${\bar x}$±s或n(%)或M(Q1, Q3)]
组别 n 年龄(岁) 女性 基线NIHSS评分 ONT(min) ODT(min) DNT(min) 动脉取栓 溶栓前收缩压(mmHg) 溶栓前舒张压(mmHg) 基线血糖(mmol/L) 吸烟史 高血压史 糖尿病史 心房颤动史 抗血小板药物使用史 抗凝药物使用史 卒中史 rt-PA溶栓 EMS
是 否
“—”无相关数据.NIHSS：美国国立卫生研究院卒中量表；ONT：起病至溶栓时间；ODT：起病至入院时间；DNT：入院至溶栓时间；EMS：院前急救医疗服务; rt-PA:重组组织型纤溶酶原激活剂.1 mmHg=0.133 kPa.
预后良好组 1459 66±12 527(36.1) 4(2, 8) 161(120, 216) 90(60, 140) 53(41, 70) 46(3.2) 153(140, 167) 86(77, 95) 0.38(0.33, 0.47) 395(30.5) 897(61.5) 219(15.0) 219(15.0) 190(13.0) 27(1.9) 156(10.7) 1337(91.6) 474(32.5) 985(67.5)
预后不良组 664 74±12 290(43.7) 13(7, 20) 162(123, 205) 91(60, 136) 59(45, 76) 76(11.6) 160(142, 172) 85(75, 95) 0.40(0.34, 0.49) 134(21.1) 461(69.4) 101(15.2) 229(34.5) 110(16.6) 13(2.0) 96(14.5) 652(98.2) 334(50.3) 330(49.7)
t/χ2/Z值 — -13.541 10.999 -22.3 -1.028 -0.198 -3.999 58.261 -4.130 -1.195 -3.517 18.920 12.504 0.014 103.981 4.722 0.047 6.102 33.154 61.421
P值 — ＜0.01 ＜0.05 ＜0.01 ＞0.1 ＞0.1 ＜0.01 ＜0.01 ＜0.01 ＞0.1 ＜0.01 ＜0.01 ＜0.01 ＞0.1 ＜0.01 ＜0.05 ＞0.1 ＜0.05 ＜0.01 ＜0.01
Tab 3 Univariate comparisons between patients with or without good prognosis after intravenous thrombolysis
变量 OR 95%CI P值
NIHSS：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；EMS：院前急救医疗服务.
年龄 0.968 0.958~0.979 ＜0.01
女性 1.143 0.861~1.517 ＞0.05
基线NIHSS评分 0.871 0.854~0.889 ＜0.01
起病到溶栓时间 0.997 0.994~0.999 ＜0.01
入院到溶栓时间 0.997 0.992~1.001 ＞0.05
动脉取栓 0.617 0.375~1.016 ＞0.05
溶栓前收缩压 0.993 0.987~0.999 ＜0.05
基线血糖 0.997 0.983~1.012 ＞0.05
吸烟史 1.060 0.769~1.461 ＞0.05
高血压史 0.846 0.647~1.105 ＞0.05
卒中史 0.755 0.511~1.115 ＞0.05
抗血小板药物使用史 0.996 0.694~1.428 ＞0.05
心房颤动史 0.732 0.541~0.991 ＜0.05
rt-PA溶液 1.117 0.410~3.042 ＞0.05
EMS 0.856 0.664~1.103 ＞0.05
Tab 4 Binary logistics regression analysis for good prognosis at 3-month after intravenous thrombolysis
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