院前预通知流程改善急性缺血性卒中患者血管内治疗的预后

doi:10.3969/j.issn.1673-5765.2018.02.004

摘要/Abstract

摘要：

目的血管内治疗的效益具有时间依赖性，120急救系统（emergency medical service，EMS）通过院前预通知卒中中心可以缩短起病到治疗的时间。本研究旨在观察EMS院前预通知流程（prehospital notification procedure，PNP）能否减少急性大血管闭塞（large vessel occlusion，LVO）患者血管内治疗的院内延误时间，及其对预后的影响。方法回顾性分析连续收集的行血管内治疗的LVO患者临床和影像资料。通过EMS入院并提前通知溶栓小组为PNP组，通过EMS入院但未通知溶栓小组为Non-PNP组，通过其他方式入院为Non-EMS组。预后良好定义为3个月改良Rankin量表（modified Rankin Scale，mRS）评分≤2分。比较PNP组、Non-PNP 组和Non-EMS组入院到再灌注时间（door to reperfusion time，DRT）和临床结局的差异。结果共纳入110例患者[平均年龄（68±12）岁，女性49例，占44.5%]，91例（82.7%）通过EMS入院，其中21例（19.1%）为PNP组。与Non-PNP组相比，PNP组的DRT更短（145 min vs 180 mi n，t =-2.065， P =0.043）；与Non-EMS组相比，PNP组的DRT有更短的趋势（145 min vs 194 mi n，t =2.260，P =0.055），而Non-PNP组与Non-EMS组的DRT比较差异无统计学意义（180 min vs 194 mi n，t =0.663，P =0.510）。二元Logistic回归模型显示，校正基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）、基线收缩压、高血压病史后，PNP是预后良好的独立影响因素[优势比（odds ratio，OR） 3.653，95%可信区间（confi dence i nterval ，CI ）1.085～12.301，P =0.037）。若将DRT纳入二元Logistic回归模型，DRT是预后良好的独立影响因素（OR 0.981，95%CI 0.968～0.994，P =0.005）。结论 PNP可以缩短急性缺血性卒中LVO患者血管内治疗的DRT，并改善预后。

文章导读： 本文首次明确，院前预通知流程是改善急性大血管闭塞患者血管内治疗3个月结局的有效方法。

关键词: 缺血性卒中; 大血管闭塞; 院前流程; 血管内治疗; 急救医疗体系

Abstract:

was strongly time-dependent. Emergency medical service (EMS) prehospital notification procedure (PNP) may reduce door to reperfusion time (DRT). This study was aimed to examine whether PNP by EMS providers could reduce DRT and improve neurological outcome in LVO patients who received EVT. Methods A retrospective analysis was made upon clinical and imaging data of LVO patients who received EVT and were enrolled consecutively. The effect of EMS with PNP (PNP group), EMS without PNP (Non-PNP group) and non-EMS group on DRT, and the subsequent neurological outcome were compared. Good outcome was defined as modified Rankin Scale (mRS) ≤2 at 3 month. The difference in DRT and clinical outcome were compared among PNP group, Non- PNP group and Non-EMS group. Results Finally, 110 patients were included (average age: 68±12 years, female: 49, 44.5%). Among which, 91 (82.7%) patients were transferred by EMS, of whom 21 (19.1%) patients were PNP. There was no difference in DRT between EMS without PNP group and non-EMS group (180 min vs 194 min, t =0.663, P =0.510), while EMS with PNP group tended to have shorter DRT than non- EMS group (145 min vs 194 min, t =2.260, P =0.055) and EMS with PNP group had shorter DRT than Non-PNP group (145 min vs 180 min, t =-2.065, P =0.043). Multivariate analysis showed that EMS with PNP was independently associated with good outcome after adjusting for hypertension, baseline systolic blood pressure and baseline National Institute of Health Stroke Scale (NIHSS) [odds ratio (OR) 3.653, 95% confidence interval (CI) 1.085-12.301, P =0.037]. When DRT was included in the regression model, DRT was independently associated with good outcome (OR=0.981, 95%CI 0.968-0.994, P =0.005). Conclusion PNP can improve neurological outcome by shortening door to reperfusion time in patients with endovascular treatment and improve the clinical outcome.

Key words: Acute ischemic stroke; Large vessel occlusion; Prehospital notification procedure;Endovascular treatment; Emergency medical service

张美霞, 陈智才, 张睿婷, 史飞娜, 楼敏. 院前预通知流程改善急性缺血性卒中患者血管内治疗的预后[J]. 中国卒中杂志, 2018, 13(02): 114-121.

ZHANG Mei-Xia, CHEN Zhi-Cai, ZHANG Rui-Ting, SHI Fei-Na, LOU Min. Prehospital Notification Procedure Improves Endovascular Treatment Outcome in Patients with Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2018, 13(02): 114-121.

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