国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
6期
401-405
,共5页
石铸%屈剑锋%罗根培%李爱萍%袁锡球%陈仰昆%郑伟城%丘东海
石鑄%屈劍鋒%囉根培%李愛萍%袁錫毬%陳仰昆%鄭偉城%丘東海
석주%굴검봉%라근배%리애평%원석구%진앙곤%정위성%구동해
卒中%脑缺血%住院%急救医疗服务%时间因素
卒中%腦缺血%住院%急救醫療服務%時間因素
졸중%뇌결혈%주원%급구의료복무%시간인소
Stroke%Brain Ischemia%Hospitalization%Emergency Medical Services%Time Factors
目的 探讨东莞地区急性缺血性卒中患者院前延误的特征和影响因素.方法 前瞻性连续登记2012年5月1日至2012年9月30日期间因急性缺血性卒中入院治疗的患者,采用问卷和访视调查方法调查院前延误(从卒中症状出现至做出就医决定)和运送所需时间(从做出就医决定至到达医院),记录卒中现场情况、认识行为和社会人口学变量等,采用单变量和多变量分析方法研究院前就诊延误的影响因素.结果 共纳入151例急性缺血性卒中患者,其中53例(35.1％)在发病2h内做出早期就医决定(早期就医决定组),98例(64.9％)发病2h后做出就医决定(就医决定延误组).早期就医决定组入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[中位数(median,M),四分位数间距(interquartile range,IQR):5.0(3.0～12.0)分对4.0(2.0～6.0)分,Z=-2.342,P=0.019]以及发病时有旁观者(94.3％对37.8％;x2=42.812,P＜0.001)、意识到发生卒中(62.3％对39.8％;x2=6.961,P=0.008)、知晓溶栓治疗(22.6％对3.1％;x2 =12.632,P＜0.001)的患者比例均显著性高于就医决定延误组,两组间转运方式存在显著性差异(x2 =22.696,P＜0.001);早期就医决定组入院时Barthel指数(M,IQR)[65.0(40.0 ～ 80.0)分对80.0(60.0 ～90.0)分;Z=-3.210,P=0.001]显著性低于就医决定延误组,认识和决定时间显著性短于就医决定延误组[(1.04±0.62)h对(13.8±11.9)h;Z=-7.748,P＜0.001],但转送时间无显著性差异[(2.07±4.24)h对(2.08±4.58)h;t-0.160,P=0.987].多变量logistic回归分析显示,发病时有旁观者是促进早期决定就医的独立影响因素[优势比(odds raio,OR)0.046,95％可信区间(confidence interval,CI)0.013 ～0.163; P＜ 0.001],而基线Barthel指数较高(OR 1.022,95％ CI1.004 ～1.040;P =0.016)和夜间发病(OR 1.258,95％ CI1.043～1.517;P=0.034)则是造成就医决定延误的独立影响因素.结论 就医决定延误是急性缺血性卒中院前延误的主要原因,旁观者是减少决定延误的重要因素,普及和加强高危社区中青年旁观者人群的卒中健康教育有可能使更多急性缺血性卒中患者从溶栓治疗中获益.
目的 探討東莞地區急性缺血性卒中患者院前延誤的特徵和影響因素.方法 前瞻性連續登記2012年5月1日至2012年9月30日期間因急性缺血性卒中入院治療的患者,採用問捲和訪視調查方法調查院前延誤(從卒中癥狀齣現至做齣就醫決定)和運送所需時間(從做齣就醫決定至到達醫院),記錄卒中現場情況、認識行為和社會人口學變量等,採用單變量和多變量分析方法研究院前就診延誤的影響因素.結果 共納入151例急性缺血性卒中患者,其中53例(35.1％)在髮病2h內做齣早期就醫決定(早期就醫決定組),98例(64.9％)髮病2h後做齣就醫決定(就醫決定延誤組).早期就醫決定組入院時美國國立衛生研究院卒中量錶(National Institutes of Health Stroke Scale,NIHSS)評分[中位數(median,M),四分位數間距(interquartile range,IQR):5.0(3.0～12.0)分對4.0(2.0～6.0)分,Z=-2.342,P=0.019]以及髮病時有徬觀者(94.3％對37.8％;x2=42.812,P＜0.001)、意識到髮生卒中(62.3％對39.8％;x2=6.961,P=0.008)、知曉溶栓治療(22.6％對3.1％;x2 =12.632,P＜0.001)的患者比例均顯著性高于就醫決定延誤組,兩組間轉運方式存在顯著性差異(x2 =22.696,P＜0.001);早期就醫決定組入院時Barthel指數(M,IQR)[65.0(40.0 ～ 80.0)分對80.0(60.0 ～90.0)分;Z=-3.210,P=0.001]顯著性低于就醫決定延誤組,認識和決定時間顯著性短于就醫決定延誤組[(1.04±0.62)h對(13.8±11.9)h;Z=-7.748,P＜0.001],但轉送時間無顯著性差異[(2.07±4.24)h對(2.08±4.58)h;t-0.160,P=0.987].多變量logistic迴歸分析顯示,髮病時有徬觀者是促進早期決定就醫的獨立影響因素[優勢比(odds raio,OR)0.046,95％可信區間(confidence interval,CI)0.013 ～0.163; P＜ 0.001],而基線Barthel指數較高(OR 1.022,95％ CI1.004 ～1.040;P =0.016)和夜間髮病(OR 1.258,95％ CI1.043～1.517;P=0.034)則是造成就醫決定延誤的獨立影響因素.結論 就醫決定延誤是急性缺血性卒中院前延誤的主要原因,徬觀者是減少決定延誤的重要因素,普及和加彊高危社區中青年徬觀者人群的卒中健康教育有可能使更多急性缺血性卒中患者從溶栓治療中穫益.
목적 탐토동완지구급성결혈성졸중환자원전연오적특정화영향인소.방법 전첨성련속등기2012년5월1일지2012년9월30일기간인급성결혈성졸중입원치료적환자,채용문권화방시조사방법조사원전연오(종졸중증상출현지주출취의결정)화운송소수시간(종주출취의결정지도체의원),기록졸중현장정황、인식행위화사회인구학변량등,채용단변량화다변량분석방법연구원전취진연오적영향인소.결과 공납입151례급성결혈성졸중환자,기중53례(35.1％)재발병2h내주출조기취의결정(조기취의결정조),98례(64.9％)발병2h후주출취의결정(취의결정연오조).조기취의결정조입원시미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평분[중위수(median,M),사분위수간거(interquartile range,IQR):5.0(3.0～12.0)분대4.0(2.0～6.0)분,Z=-2.342,P=0.019]이급발병시유방관자(94.3％대37.8％;x2=42.812,P＜0.001)、의식도발생졸중(62.3％대39.8％;x2=6.961,P=0.008)、지효용전치료(22.6％대3.1％;x2 =12.632,P＜0.001)적환자비례균현저성고우취의결정연오조,량조간전운방식존재현저성차이(x2 =22.696,P＜0.001);조기취의결정조입원시Barthel지수(M,IQR)[65.0(40.0 ～ 80.0)분대80.0(60.0 ～90.0)분;Z=-3.210,P=0.001]현저성저우취의결정연오조,인식화결정시간현저성단우취의결정연오조[(1.04±0.62)h대(13.8±11.9)h;Z=-7.748,P＜0.001],단전송시간무현저성차이[(2.07±4.24)h대(2.08±4.58)h;t-0.160,P=0.987].다변량logistic회귀분석현시,발병시유방관자시촉진조기결정취의적독립영향인소[우세비(odds raio,OR)0.046,95％가신구간(confidence interval,CI)0.013 ～0.163; P＜ 0.001],이기선Barthel지수교고(OR 1.022,95％ CI1.004 ～1.040;P =0.016)화야간발병(OR 1.258,95％ CI1.043～1.517;P=0.034)칙시조성취의결정연오적독립영향인소.결론 취의결정연오시급성결혈성졸중원전연오적주요원인,방관자시감소결정연오적중요인소,보급화가강고위사구중청년방관자인군적졸중건강교육유가능사경다급성결혈성졸중환자종용전치료중획익.
Objective To investigate the characteristics of prehospital delay and influencing factors in patients with acute ischemic stroke in Dongguan,Guangdong.Methods Consecutive inpatients with acute ischemic stroke were registered prospectively from May 1,2012 to September 30,2012.Questionnaires and interviews were used to investigate the pre-hospital delay (from the time of stroke onset to decision to seek medical help) and the time needed for transportation (from medical decision to arriving at the hospital).The variables such as the scene of stroke,cognitive behavior,and sociodemography were documented.Univariate and multivariate analyses were used to study the influencing factors for prehospital delay.Results A total of 151 patients with acute ischemic stroke were enrolled,and 53 of them (35.1％) made decision to seek medical help within 2 hours after symptom onset (early decision group); 98 of them made decision to seek medical help after 2 hours of symptom onset (decision delay group).The National Institutes of Health Stroke Scale (NIHSS) scores (median [M],interquartile range [IQR]:5.0 [3.0-12.0] vs.4.0 [2.0-6.0] ; Z =-2.342,P =0.019),and the proportions of presence of bystander at the time of symptom onset (94.3％ vs.37.8％;x2 =42.812,P＜0.001),awaring of the onset of stroke (62.3％ vs.39.8％;x2 =6.961,P =0.008),knowing thrombolytic treatment (22.6％ vs.3.1％ ; x2 =12.632,P ＜ 0.001) in the early decision group were significantly higher than those in the decision delay group; there were significant difference in the proportions of transport modes between the early decision group and the decision delay group (x2 =22.696,P＜ 0.001).Barthel index on admission (M,IQR) (65.0 [40.0-80.0] vs.80.0 [60.0-90.0]; Z=-3.210,P=0.001) in the early decision group was significantly lower than that in the decision delay group.The time of recognizing and making decision was significantly shorter than that in the decision delay group (1.04 ±0.62 h vs.13.8 ± 11.9 h; P=-7.748,P＜0.001),but there was no significant difference in transport time (2.07 ± 4.24 h vs.2.08 ± 4.58 h; t =-0.160,P =0.987).Multivariate logistic regression analysis showed that presence of bystander at the time of symptom onset was an independent influencing factor for early decision to seek medical help (odds ratio [OR] 0.046,95％confidence interval [CI]0.013-0.163; P ＜ 0.001),while the higher baseline Barthel index (OR 1.022,95％ CI 1.004-1.040; P =0.016) and the onset at night (OR 1.258,95％ CI 1.043-1.517; P =0.034)were the independent influencing factors for decision delay.Conclusions The decision delay to seek medical help is a main reason for prehospital delay in acute ischemic stroke.Presence of bystander at the time of symptom onset is an important factor for decreasing decision delay.The popularity and strengthen the health education of stroke among the population of young and middle-aged bystanders may enable more patients with acute ischemic stroke benefit from thrombolysis therapy.
