2020中国急性缺血性卒中血管内治疗现状调查分析

doi:10.3969/j.issn.1673-5765.2022.01.008

摘要/Abstract

摘要：

目的调查2020年中国急性缺血性卒中（acute ischemic stroke，AIS）血管内治疗（endovascular treatment，EVT）的数量、分布及特点。

方法通过国家神经系统疾病医疗质量控制中心神经介入质量控制专家委员会调研及上报方式，对中国2020年开展AIS-EVT（包括动脉溶栓、机械取栓、球囊成形、支架成形）的中心数量及AIS-EVT 数量进行调查，分析年AI S-EVT治疗量50例以上和100例（高容量中心）以上中心的分布特点。结合中国第七次人口普查结果，计算中国AIS-EVT中心及数量的人口分布情况。结合2020年国民生产总值（gross domestic product，GDP）及人均GDP情况，分析AIS-EVT数量和每10万人口AIS-EVT数量与各区域 GDP和人均GDP的相关性。

结果各区域质量控制中心上报2020年开展AIS-EVT的中心数量共862家，实施AIS-EVT共42 183例。年治疗50例以上中心为275家，总计AI S-EVT数量达30 855例，前六名为广东省、江苏省、河南省、山东省、四川省、浙江省；年治疗100例以上的中心数量为126家，总计AI S-EVT数量达20 642例，前六名为广东省、江苏省、河南省、山东省、浙江省、上海市。全国每千万人口AIS-EVT中心数量为6.11家，前六名为陕西省、新疆维吾尔自治区、浙江省、四川省、北京市、天津市。每10万人口AIS-EVT数量平均为3例，前六名为上海市、北京市、浙江省、江苏省、陕西省、广东省。各区域AIS-EVT数量与本地区的人口数量正相关（r =0.870，P <0.001），也与本地区GDP正相关（r =0.940，P <0.001）；各区域每10万人口AIS-EVT 数量与本地区人均GDP正相关（r =0.529，P =0.002）。

结论 2020年中国有862家的中心开展AIS-EVT，累计AI S-EVT数量超过4万例，每10万人口AI S-EVT数量为3例，比例尚有待进一步提高。地区的GDP总量与AI S-EVT数量密切相关，AI S-EVT技术的人群覆盖情况与人均GDP密切相关，AI S-EVT技术有待于进一步的下沉及均质化发展。

文章导读： 2020年中国有862家中心开展急诊AIS-EVT治疗，累计AI S-EVT数量达42 183例，每千万人口AI S-EVT中心为6.11家，每10万人口AI S-EVT数量为3例，AI S-EVT的比例尚有待进一步提高。地区的GDP总量和人均GDP影响AIS-EVT治疗的数量。

关键词: 急性缺血性卒中; 大血管闭塞; 血管内治疗; 动脉溶栓; 机械取栓; 球囊成形; 支架成形; 国民生产总值; 地图

Abstract:

Objective To investigate the prevalence, distribution and characteristics of endovascular treatment (EVT) of acute ischemic stroke (AIS) patients in China in 2020.

Methods A survey on AIS-EVT was carried out by the Expert Committee for Neurointervention Quality Control of National Center for Healthcare Quality Management in Neurological Diseases, which including the number of centers capable of performing AIS-EVT (including intra-artery thrombolysis, mechanical thrombectomy, balloon angioplasty, stent angioplasty) and number of AIS-EVT surgery, to analyze the distribution characteristics of centers with high capacity for AISEVT treatment (more than 50 cases and more than 100 cases). Combined with the gross domestic product (GDP) and per capita GDP of each region in 2020, the correlation between the number of AIS-EVT, the number of AIS-EVT per 100 000 population and GDP and per capita GDP of each region were analyzed.

Results There were 862 centers and 42 183 cases receiving AIS-EVT in all in this survey. There were 275 centers capable for treating more than 50 cases per year and the number of AIS-EVT amounted to 30 855 cases, the top six provinces of which were Guangdong, Jiangsu, He'nan, Shandong, Sichuan and Zhejiang. There were 126 centers capable for treating more than 100 cases per year, and the total number of AIS-EVT reached up to 20 642 cases, the top six regions of which were Guangdong, Jiangsu, He'nan, Shandong, Zhejiang and Shanghai. The average number of thrombectomy centers per 10 million population was 6.11, and the top six provinces were Shaanxi, Xinjiang, Zhejiang, Sichuan, Beijing and Tianjin. The average number of thrombectomy per 100 000 population was 3 cases, and the top six regions were Shanghai, Beijing, Zhejiang, Jiangsu, Shaanxi and Guangdong. The AIS-EVT number in each region was positively correlated with the population of this region (r =0.870, P <0.001), and also with GDP of this region (r =0.940, P <0.001). The number of thrombectomy per 100 000 population in each region was positively correlated with per capita GDP in this region (r =0.529, P =0.002).

Conclusions In 2020, 862 centers performed AIS-EVT in China, and the cumulative number of AIS-EVT reached up to 42 183 cases, with 3 thrombectomy per 100 000 population. The proportion of thrombectomy needs to be further improved. The number of AIS-EVT was closely related to the total GDP of a region, and the status of AIS-EVT covering the population was closely related to per capita GDP, which suggested that AIS-EVT needs to be further promoted to primary hospitals and homogenized.

Key words: Acute ischemic stroke; Large vessel occlusion; Endovascular treatment; Intraartery thrombolysis; Mechanical thrombectomy; Balloon angioplasty; Stent angioplasty; Gross domestic product; Map

霍晓川, 李晓青, 缪中荣, 国家神经系统疾病医疗质量控制中心神经介入质控专家委员会, 急性脑梗死再灌注治疗质量改进国家行动血管内治疗工作委员会. 2020中国急性缺血性卒中血管内治疗现状调查分析[J]. 中国卒中杂志, 2022, 17(01): 56-65.

HUO Xiaochuan, LI Xiaoqing, MIAO Zhongrong, Expert Committee for Neurointervention Quality Control of National Center for Healthcare Quality Management in Neurological Diseases, Endovascular Treatment Working Committee of National Action for Quality Improvement of Acute Cerebral Infarction Reperfusion Therapy. A Survey of Current Practice in Acute Ischemic Stroke Endovascular Treatment in China in 2020[J]. Chinese Journal of Stroke, 2022, 17(01): 56-65.

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