目的 探讨院前转运方式对急性卒中患者治疗延误的影响.方法 前瞻性连续纳入2016年3月至8月首都医科大学宣武医院符合纳入标准的急性卒中患者255例,排除资料不全7例,获得有效病例248例.依据是否通过急救车转运到院,分为急救车组(88例)和非急救车组(160例),比较两组基线资料、院前情况、发病至到院时间、到院至评估时间、到院至CT检查时间、到院至静脉溶栓时间的差异,并分析急性卒中患者急救车利用的相关因素及院前转运方式选择的原因.结果 (1)248例患者急救车利用率为35.5%.急救车组患者年龄、冠心病比例、美国国立卫生研究院卒中量表(NIHSS)评分高于非急救车组[(65±11)岁比(61±11)岁、15.9%(14/88)比5.6%(9/160)、9(3,17)分比2(1,5)分],卒中比例低于非急救车组[23.9%(21/88)比37.5%(60/160)],组间差异均有统计学意义(均P<0.05).(2)急救车组与非急救车组的自我判断病情紧急与自我保健意识的差异均有统计学意义(均P<0.01).(3)与非急救车组相比,急救车组患者发病至到院时间,到院至评估时间、CT检查时间、静脉溶栓时间更短[102(64,150)min比136(86,230)min、3(1,8)min比7(4,11)min、15(18,23)min比16(22,27)min、(41±9)min比(50±10)min,均P<0.05].(4)Logistic回归结果显示,年龄大(OR=1.04,95%CI:1.01~1.08,P=0.01)、NIHSS评分高(OR=1.13,95%CI:1.08~1.19,P<0.01)、患者或知情人判断病情紧急(OR=17.08,95%CI:5.78~50.41,P<0.01)、不适会及时就诊(OR=38.13,95%CI:10.13~143.61,P<0.01)、不适会自行服药(OR=6.82,95%CI:2.33~19.99,P<0.01)的急性卒中患者更倾向于通过急救车转运到院.结论 使用急救车可减少急性卒中患者的治疗延误,有自我保健意识者更易选择急救车转运.对卒中患者应加强利用急救车重要性的宣教.%Objective To investigate the effect of prehospital transport mode on delay care in patients withacutestroke.Methods From March 2016 to August 2016,a total of 255 consecutive patients with acute stroke who met the inclusion criteria in Xuanwu Hospital,Capital Medical University were analyzed prospectively. Seven patients were excluded because of incomplete data. A total of 248 valid cases were enrolled. They were divided into either an ambulance transport group (n=88)or a non-ambulance transport group (n=160)according to whether they were transported by ambulance or not. The differences of the baseline data,prehospital status,onset-to-door time,door-to-examination time,door-to-CT scan time,door-to-intravenous thrombolysis time of the 2 groups were compared,and the related factors of ambulance use were analyzed in patients with acute stroke. Results (1)The ambulance utilization rate of 248 patients was 35. 5%. The age,the coronary heart disease rate,National Institutes of Health Stroke Scale (NIHSS)score of the patients in the ambulance transport group were higher than those of the non-ambulance transport group. There were significant differences between the two groups (65 ± 11 vs. 61 ± 11 years,15. 9%[14/88]vs. 5. 6%[9/160],9 [3,17]vs. 2 [1,5];all P <0. 05). The stroke rate of the patients in the ambulance transport group was lower than that of the non-ambulance transport group(23. 9%[21/88]vs. 37. 5%[60/160],P<0. 05). (2)There were significant differences in self-identified acute disease and self-health care consciousness between the ambulance transport group and the non-ambulance transport group (all P<0. 01). (3)Compared with the non-ambulance transport group,the onset-to-door time,door-to-examination time,door-to-CT scan time,door-to-intravenous thrombolysis time were shorter in patients of the ambulance transport group (102[64,150]min vs. 136[86,230]min,3[1,8]min vs. 7[4,11]min, 15[18,23]min vs. 16[22,27]min,and 41 ± 9 min vs. 50 ± 10 min;all P <0. 05). (4)The result of Logistic regression analysis showed that the acute stroke patients with advanced age (OR,1. 04,95%CI 1. 01-1. 08,P =0. 01),higher NIHSS score (OR,1. 13,95%CI 1. 08-1. 19,P <0. 01),they or the insiders thought that the disease was emergent (OR,17. 08,95%CI 5. 78-50. 41,P<0. 01),they would seek medical advice in time when they felt sick (OR,38. 13,95%CI 10. 13-143. 61,P<0. 01),and they would take medicine by themselves when they felt sick (OR,6. 82,95%CI 2. 33-19. 99,P<0. 01)were more likely to be transported to hospital by ambulance.Conclusion Using ambulance can reduce the treatment de-lay for patients with acute stroke. The patients with self-health care consciousness are more likely to choose am-bulance transport. The importance of using ambulance should be strengthened for patients with stroke.
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