急性缺血性脑卒中患者静脉溶栓现况及院前延迟的影响因素分析

摘要

目的：了解急性缺血性脑卒中患者静脉溶栓治疗的现况及院前延迟的影响因素，为促进急性缺血性脑卒中患者及早就诊提供科学指导。方法采用自制调查表收集安徽省某三级甲等医院147例急性缺血性脑卒中患者急诊救治的临床资料，描述性分析急性缺血性脑卒中患者静脉溶栓现况，采用非条件多因素Logistic回归分析发生院前延迟的影响因素。结果147例患者中119例发生院前延迟（81.0%）；28例正常入院（19.0%），其中静脉溶栓治疗仅4例，溶栓率为14.3%（4/28）；既往脑卒中风险程度不同的患者急诊就诊时间差异无统计学意义（P=0.961），既往脑卒中风险程度分级越高的患者，接受过缺血性脑卒中相关知识宣教的可能性越高（字2趋势=7.597，P＜0.05）；单因素分析提示：独居、发病时居住于合肥市外或其他地区、通过私人交通工具转运、首发症状为其他症状以及既往未曾接受过相关知识宣教的患者更有可能发生院前延迟（P＜0.05）；多因素 Logistic回归分析显示：发病时居住地类型（OR=7.289，95%CI：2.146～24.756，P＜0.01）和疾病相关知识宣教（OR=5.109，95%CI：1.868～13.970，P＜0.01）是影响患者及时就诊的主要因素。结论急性缺血性脑卒中患者静脉溶栓现况极不理想，院前延迟普遍，强化脑卒中知识宣传力度，提高患者就诊及时性，是改善急性缺血性脑卒中患者预后，提高患者生活质量的关键。%Objective To study the current status of intravenous thrombolysis and influence factors of pre-hospital delay among patients with acute ischemic stroke, to provide scientific evidences for promoting the immediate visitor to doctors among patients with acute ischemic stroke. Methods The relevant data of 147 patients with acute ischemic stroke at certain Class ⅢGrade Ⅰhospital in Anhui Province were collected by a self-designed questionnaire and the current status of intravenous thrombolysis and the factors impacting pre-hospital delay for inpatients with acute ischemic stroke were analyzed. Results Of the total, only 28 inpatients were with normal admission (19.0%) while 119 patients with pre-hospital delay (81.0%) and 4 cases were treated with intravenous thrombolysis, with a thrombolysis rate of 14.3%;there was no significant difference on the time of emergency visit among patients with different risk of stroke(P=0.961).Patients with higher risk of stroke had the much higher possibility of health education( χ2 trend=7.597, P<0.05); univariate analysis showed that the people living alone, those living in areas far away from the city at the onset of stroke, transited through private transportation, different first symptoms and without relevant stroke knowledge were confronted with greater possibility of pre-hospital delay (P<0.05);multiple factor logistic regression analysis indicated that inhabiting area at the onset of stroke (OR=7.289,95%CI:2.146~24.756, P<0.01) and related knowledge education (OR=5.109,95% CI:1.868~13.970, P<0.01) were the major factors influencing timeliness of admission. Conclusion Health education and the improvement of the timeliness of admission are keys to ameliorate the clinical outcome and enhance the quality of life for patients with acute ischemic stroke.