院前通知对急性颅内大动脉闭塞患者取栓流程及疗效的影响

doi:10.3969/j.issn.1673-5765.2018.02.003

摘要/Abstract

摘要：

目的探讨院前通知对取栓患者入院-再灌注时间（door-to-reperfusion time，DRT）和临床预后的影响。方法回顾性分析2015年1月-2016年12月在浙江省人民医院神经内科接受取栓患者的临床和影像学资料。将院前通知定义为当地医院在患者转运之前向本中心卒中小组进行短信告知。对院前通知和非院前通知组的基线特点，以及两组DRT和预后进行比较。预后良好定义为3个月改良Rankin量表评分≤3分。结果共纳入123例接受取栓治疗的缺血性卒中患者，57例（46.3%）患者在转运到达前进行了院前通知。在术后达到再灌注的人群中（100例），与非院前通知组患者相比，院前通知组患者的DRT明显较短（P＜0.001）。术前静脉溶栓[优势比（odds ratio，OR）=2.774，P =0.023]是预后良好的独立影响因素，院前通知不是影响预后的独立因素（OR =2.586，P =0.058）。但院前通知联合术前静脉溶栓是预后良好的独立影响因素（OR =7.662，P =0.006）。结论院前通知可以缩短DRT。在取栓后达到再灌注的人群中，术前进行静脉溶栓能够使患者获益，而术前静脉溶栓联合院前通知将使获益概率增加2.7倍。

文章导读： 转运过程中对综合卒中中心进行院前通知将有效提高取栓效率，大幅缩短获得再灌注的时间。发病6 h内，取栓前进行静脉溶栓仍然优于直接取栓。

关键词: 血管内治疗; 院前通知; 急救网络; 时间管理; 预后

Abstract:

Objective To investigate the impact of prehospital notification (PN) on the door-to-reperfusion time (DRT) and outcome of patients who underwent thrombectomy. Methods A retrospective analysis was made upon clinical and imaging data of patients who underwent thrombectomy in Zhejiang Provincial People's Hospital from January 2015 to December 2016. PN was defined as a local hospital informing our stroke team prior to the transfer of thrombectomy candidates. The baseline characteristics, DRT and outcome between patients with and without PN were compared. Good outcome was defined as modified Rankin Scale score ≤3 at 3 months. Results A total of 123 patients underwent thrombectomy were enrolled, including 57 (46.3%) patients that was identified as PN group. Among patients who achieved reperfusion after thrombectomy (n =100), the DRT of PN group was significantly shorter than that of non-PN group (P <0.001). Implementing intravenous thrombolysis before thrombectomy [odds ratio (OR)=2.774, P =0.023] was an independent factor for good outcome, while PN was not (OR=2.586, P =0.058).Nevertheless, PN combined with preoperative intravenous thrombolysis was an independent factor for good outcome (OR =7.662, P =0.006).

Conclusion PN can shorten DRT. Patients who achieved reperfusion after thrombectomy could benefit from preoperative intravenous thrombolysis. PN combined with preoperative intravenous thrombolysis would increase the beneficial rate by 2.7 times.

Key words: Endovascular therapy; Prehospital notification; Emergency network; Time management; Outcome

张圣, 史宗杰, 王振, 刘芳, 陈波, 张凝远, 徐天波, 耿昱. 院前通知对急性颅内大动脉闭塞患者取栓流程及疗效的影响[J]. 中国卒中杂志, 2018, 13(02): 106-113.

ZHANG Sheng, SHI Zong-Jie, WANG Zhen, LIU Fang, CHEN Bo, ZHANG Ning-Yuan, XU Tian-Bo, GENG Yu. The Impact of Prehospital Notification on Door-to-reperfusion Time and Clinical Outcome after Thrombectomy[J]. Chinese Journal of Stroke, 2018, 13(02): 106-113.

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