院内急性缺血性卒中血管内介入治疗延误的影响因素分析

doi:10.3969/j.issn.1673-5765.2020.08.010

摘要/Abstract

摘要：

目的分析院内急性缺血性卒中（acute ischemic stroke，AIS）患者血管内介入治疗延误的影响因素。方法回顾性纳入2014年10月-2019年7月于南京医科大学第一附属医院住院期间发生AIS并接受血管内介入治疗的患者，根据发病至股动脉穿刺时间（onset-to-puncture time，OTP）是否超过120 min，将患者分为延误组和非延误组。收集两组患者相关临床资料，观察两组预后情况，良好预后定义为 90 d mRS评分≤2分，采用多因素Logistic回归分析研究院内延误的影响因素。结果共纳入53例院内卒中患者，平均年龄64.43±12.46岁，男性29例（54.72%）。中位OTP为150 （115～200）min，其中延误组31例，非延误组22例。非延误组良好预后比例高于延误组（63.64% vs 35.48%，P =0.043）。多因素Logistic回归分析显示，发病后立即启动绿色通道（OR 0.061，95%CI 0.007～0.532，P =0.011）及高危科室发病（OR 0.108，95%CI 0.014～0.821；P =0.031）与院内卒中血管内介入治疗延误呈独立负相关；而家属决策时间延长（OR 1.527，95%CI 1.114～2.094，P =0.008）与院内卒中血管内介入治疗延误呈独立正相关。结论家属决策时间长是院内卒中血管内介入治疗延误的独立危险因素，发病后立即启动绿色通道及高危科室发病是院内卒中血管内介入治疗延误的独立保护因素。

文章导读： 本研究探讨了院内卒中血管内介入治疗延误的影响因素，为改进并完善院内卒中救治流程提供依据。

关键词: 院内卒中; 血管内治疗; 延误; 影响因素

Abstract:

Objective The data of patients with acute ischemic stroke (AIS) who received endovascular treatment were analyzed to investigate the influencing factors for the delay of endovascular treatment for in-hospital stroke. Methods Patients with in-hospital onset AIS and received endovascular treatment from the First Affiliated Hospital with Nanjing Medical University between October 2014 and July 2019 were retrospectively enrolled in this study, and the clinical data were collected. The patients were divided into two groups: delay group and non-delay group, according to whether the onset-to-puncture (OTP) time was more than 120 minutes. Good outcome was defined as a 90-day mRS score of 0 to 2. Multivariate logistic regression analysis was used to investigate the factors associated with the delay of endovascular treatment. Results A total of eligible 53 patients were included, with a mean age of 64.43±12.46 years and 29 (54.72%) men, including 31 patients in delay group and 22 in no-delay group. The median (IQR) OTP time was 150 (115-200) minutes. The proportion of patients with good outcome in non-delay group was higher than that in delay group (63.64% vs 35.48%, P =0.043). Multivariate logistic regression analysis showed that starting the fast track upon onset (OR 0.061, 95%CI 0.007-0.532, P =0.011) and stroke onset in the high-risk department (OR 0.108, 95%CI 0.014-0.821, P =0.031) were negatively correlated with the delay of endovascular treatment, while long decision-making time of the patient’s relatives (OR 1.527, 95%CI 1.114-2.094, P =0.008) was positively correlated with the delay. Conclusions Long decision-making time of the patient’s relatives was the independent risk factor for delay of endovascular treatment of in-hospital stroke, while the high-risk departments and starting fast track upon stroke onset were independent protective factors for delay of endovascular treatment.

Key words: In-hospital Stroke; Endovascular treatment; Delay; Influencing Factor

刘钦晨，贾振宇，赵林波，曹月洲，周春高，施海彬，刘圣. 院内急性缺血性卒中血管内介入治疗延误的影响因素分析[J]. 中国卒中杂志, 2020, 15(08): 876-880.

LIU Qin-Chen, JIA Zhen-Yu, ZHAO Lin-Bo, CAO Yue-Zhou, ZHOU Chun-Gao, SHI Hai-Bin, LIU Sheng. Analysis of Influencing Factors for Delayed Endovascular Treatment of In-hospital Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2020, 15(08): 876-880.

参考文献

[1] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国急性缺血性脑卒中诊治指南

2018[J]. 中华神经科杂志，2018，51（9）：666-682.

[2] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组，中华医学会神经病学分会神经血

管介入协作组. 中国急性缺血性脑卒中早期血管内介

入诊疗指南2018[J]. 中华神经科杂志，2018，51（9）：

683-691.

[3] SALTMAN A P，SILVER F L，FANG J M，et al.

Care and outcomes of patients with in-hospital stroke

[J]. JAMA Neurol，2015，72（7）：749-755.

[4] CAPARROS F，FERRIGNO M，DECOURCELLE

A，et al. In-hospital ischaemic stroke treated

with intravenous thrombolysis or mechanical

thrombectomy[J]. J Neurol，2017，264（8）：1804-

1810.

[5] KIRCHER C，KREITZER N，ADEOYE O. Pre and

intrahospital workflow for acute stroke treatment[J].

Curr Opin Neurol，2016，29（1）：14-19.

[6] CUMBLER E. In-hospital ischemic stroke[J].

Neurohospitalist，2015，5（3）：173-181.

[7] MÖNCH S，LEHM M，MAEGERLEIN C，et

al. Worse endovascular mechanical recanalization

results for patients with in-hospital onset acute

ischemic stroke[J]. J Neurol，2018，265（11）：2525-

2530.

[8] FURIE K L，JAYARAMAN M V. 2018 Guidelines

for the early management of patients with acute

ischemic stroke[J]. Stroke，2018，49（3）：509-510.

[9] SACKS D，BLACK C M，COGNARD C，et

al. Multisociety consensus quality improvement

guidelines for intraarterial catheter-directed

treatment of acute ischemic stroke，from

the American Society of Neuroradiology，

Canadian Interventional Radiology Association，

Cardiovascular and Interventional Radiological

Society of Europe，Society for Cardiovascular Angiography and Interventions，Society

of Interventional Radiology，Society of

NeuroInterventional Surgery，European Society

of Minimally Invasive Neurological Therapy，and

Society of Vascular and Interventional Neurology[J/

OL]. Catheter Cardiovasc Interv，2013，82（2）：E52-

68[2020-01-21]. https：//doi.org/10.1002/ccd.24862.

[10] FROMM A. No time to hesitate in acute in-hospital

stroke![J]. Eur J Neurol，2018，25（2）：201-202.

[11] VERA R，LAGO A，FUENTES B，et al. In-hospital

stroke：a multi-centre prospective registry[J]. Eur J

Neurol，2011，18（1）：170-176.

[12] 杨建道，周永明，孟令磊，等. 静脉溶栓桥接机械取

栓治疗急性脑梗死临床效果[J]. 介入放射学杂志，

2019，28（8）：786-789.

[13] 陈付文，刘金朝，康孝理，等. Solumbra技术在急性

大动脉闭塞性脑梗死机械取栓中的初步应用观察

[J]. 介入放射学杂志，2019，28（6）：515-520.

[14] CHAI E Q，LI C Q，JIANG L，et al. Factors

affecting in-hospital delay of intravenous

thrombolysis for acute ischemic stroke：a

retrospective cohort study[J/OL]. Medicine

（Baltimore），2019，98（19）：e15422[2020-01-21].

https：//doi.org/10.1097/MD. 0000000000015422.

[15] MEHTA B P，LESLIE-MAZWI T M，CHANDRA R

V，et al. Reducing door-to-puncture times for intraarterial

stroke therapy：a pilot quality improvement

project[J/OL]. J Am Heart Assoc，2014，3（6）：

e000963[2020-01-21]. https：//doi.org/10.1161/JAHA.

114.000963.