影响急性缺血性卒中患者静脉溶栓治疗的院内延误因素分析

发布时间：2018-08-05 09:36

【摘要】：目的探讨急性缺血性卒中患者应用阿替普酶静脉溶栓治疗的院内延误影响因素。方法回顾性连续纳入2006年1月至2015年5月华北理工大学附属唐山市工人医院神经内科收治的急性缺血性卒中患者220例,均接受阿替普酶静脉溶栓治疗,入院时美国国立卫生研究院卒中量表评分平均为(16±8)分。根据患者到达医院至静脉溶栓的时间(DNT),分为延误组(DNT60 min,151例)和非延误组(DNT≤60 min,69例)。记录两组基线资料、实验室检查、发病到入院时间、影像学检查、急性卒中Org 10172治疗试验(TOAST)病因分型,对两组进行单因素分析,并进一步行多因素Logistic分析。结果 (1)非延误组既往有短暂性脑缺血发作病史的比例、入院时血糖水平、发病到入院时间均高于延误组,组间差异均有统计学意义[43.5%(30/69)比3.3%(5/151)、(7.9±3.0)mmol/L比(6.9±2.1)mmol/L、(95±53)min比(80±34)min,均P0.05];两组TOAST分型构成比差异有统计学意义(P0.05);其余基线资料及临床特征的组间差异均无统计学意义(均P0.05)。(2)多因素Logistic回归分析显示,患者既往有短暂性脑缺血发作病史(OR=0.330,95%CI:0.109~0.998,P=0.046)、入院时血糖水平升高(OR:0.775,95%CI:0.657~0.914,P=0.005)、发病到入院时间延长(OR=0.648,95%CI:0.504~0.831,P=0.013)、颈内动脉病变(OR=0.192,95%CI:0.038~0.960,P=0.044)发生溶栓治疗院内延误的风险低;入院时收缩压升高(OR=1.275,95%CI:1.091~1.491,P=0.027)、心源性脑栓塞(OR=3.892,95%CI:1.661~9.112,P=0.006)发生溶栓治疗院内延误的风险高。结论患者既往有短暂性脑缺血发作病史、入院时血糖较高、发病到入院时间较长、存在颈内动脉病变,可能引起家属和诊后医师的重视,不易发生溶栓院内延误,而入院时收缩压较高、心源性脑栓塞易发生院内延误。
[Abstract]:Objective to investigate the factors affecting hospital delay in patients with acute ischemic stroke treated with intravenous thrombolytic therapy. Methods A total of 220 patients with acute ischemic stroke admitted from January 2006 to May 2015 in the Department of Neurology, Tangshan Workers Hospital affiliated to Huabei University of Science and Technology were treated with intravenous thrombolytic therapy with atepulase. The average stroke scale score at admission was (16 卤8). According to the time from hospital to intravenous thrombolysis, (DNT), was divided into delayed group (DNT60 group, n = 151) and non-delayed group (DNT 鈮，

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