【摘要】：目的探討急性缺血性卒中患者應(yīng)用阿替普酶靜脈溶栓治療的院內(nèi)延誤影響因素。方法回顧性連續(xù)納入2006年1月至2015年5月華北理工大學(xué)附屬唐山市工人醫(yī)院神經(jīng)內(nèi)科收治的急性缺血性卒中患者220例,均接受阿替普酶靜脈溶栓治療,入院時(shí)美國國立衛(wèi)生研究院卒中量表評分平均為(16±8)分。根據(jù)患者到達(dá)醫(yī)院至靜脈溶栓的時(shí)間(DNT),分為延誤組(DNT60 min,151例)和非延誤組(DNT≤60 min,69例)。記錄兩組基線資料、實(shí)驗(yàn)室檢查、發(fā)病到入院時(shí)間、影像學(xué)檢查、急性卒中Org 10172治療試驗(yàn)(TOAST)病因分型,對兩組進(jìn)行單因素分析,并進(jìn)一步行多因素Logistic分析。結(jié)果 (1)非延誤組既往有短暫性腦缺血發(fā)作病史的比例、入院時(shí)血糖水平、發(fā)病到入院時(shí)間均高于延誤組,組間差異均有統(tǒng)計(jì)學(xué)意義[43.5%(30/69)比3.3%(5/151)、(7.9±3.0)mmol/L比(6.9±2.1)mmol/L、(95±53)min比(80±34)min,均P0.05];兩組TOAST分型構(gòu)成比差異有統(tǒng)計(jì)學(xué)意義(P0.05);其余基線資料及臨床特征的組間差異均無統(tǒng)計(jì)學(xué)意義(均P0.05)。(2)多因素Logistic回歸分析顯示,患者既往有短暫性腦缺血發(fā)作病史(OR=0.330,95%CI:0.109~0.998,P=0.046)、入院時(shí)血糖水平升高(OR:0.775,95%CI:0.657~0.914,P=0.005)、發(fā)病到入院時(shí)間延長(OR=0.648,95%CI:0.504~0.831,P=0.013)、頸內(nèi)動(dòng)脈病變(OR=0.192,95%CI:0.038~0.960,P=0.044)發(fā)生溶栓治療院內(nèi)延誤的風(fēng)險(xiǎn)低;入院時(shí)收縮壓升高(OR=1.275,95%CI:1.091~1.491,P=0.027)、心源性腦栓塞(OR=3.892,95%CI:1.661~9.112,P=0.006)發(fā)生溶栓治療院內(nèi)延誤的風(fēng)險(xiǎn)高。結(jié)論患者既往有短暫性腦缺血發(fā)作病史、入院時(shí)血糖較高、發(fā)病到入院時(shí)間較長、存在頸內(nèi)動(dòng)脈病變,可能引起家屬和診后醫(yī)師的重視,不易發(fā)生溶栓院內(nèi)延誤,而入院時(shí)收縮壓較高、心源性腦栓塞易發(fā)生院內(nèi)延誤。
[Abstract]:Objective to investigate the factors affecting hospital delay in patients with acute ischemic stroke treated with intravenous thrombolytic therapy. Methods A total of 220 patients with acute ischemic stroke admitted from January 2006 to May 2015 in the Department of Neurology, Tangshan Workers Hospital affiliated to Huabei University of Science and Technology were treated with intravenous thrombolytic therapy with atepulase. The average stroke scale score at admission was (16 鹵8). According to the time from hospital to intravenous thrombolysis, (DNT), was divided into delayed group (DNT60 group, n = 151) and non-delayed group (DNT 鈮，

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