Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
Int J Stroke. 2012 Aug;7(6):511-6. doi: 10.1111/j.1747-4949.2012.00795.x. Epub 2012 Apr 12.
Maintaining a steady thrombolysis service for treatment of acute ischemic stroke 24 h/7 days is challenging. Diurnal and seasonal variability of stroke onset affects the clinical outcome of these patients.
We state that a 24 h/7 days availability of stroke-trained physicians ameliorates weekend effects and other seasonal, weekday, or non-office-hour-related influences on outcome of ischemic stroke patients treated with intravenous thrombolysis.
All consecutive ischemic stroke patients treated with thrombolysis at the Helsinki University Central Hospital were prospectively registered (n = 1581). Patients with basilar artery occlusion (n = 154) were excluded. Door-to-needle time, three-month clinical outcome as measured by the modified Rankin Scale dichotomized at 0 to 2 vs. 3 to 6, and symptomatic intracerebral hemorrhage were analyzed with logistic regression models adjusting for baseline variables. The treating physician was defined as experienced after 18 decisions made to give thrombolysis treatment.
Door-to-needle time or clinical outcome did not differ with regard to time of day or season of presentation. Higher rates of symptomatic intracerebral hemorrhage occurred in spring (odds ratio 2·06, 95% confidence interval 1·03-4·11) and fall (odds ratio 2·08, 95% confidence interval 1·03-4·18). Physician experience reduced the door-to-needle time (odds ratio 0·40, 95% confidence interval 0·32-0·50) but was not associated with patient outcome (modified Rankin scale 3 to 6, odds ratio 1·22, 95% confidence interval 0·95-1·59) or symptomatic intracerebral hemorrhage (odds ratio 0·80, 95% confidence interval 0·51-1·27) rates.
Thrombolytic therapy can be delivered at a steady service level at all times. With proper training, less-experienced physicians can provide high quality thrombolysis, but experience translates into faster treatment.
维持 24 小时/7 天的稳定溶栓服务以治疗急性缺血性脑卒中具有挑战性。卒中发病的昼夜和季节性变化会影响这些患者的临床结局。
我们提出，24 小时/7 天提供卒中培训医师可改善周末效应以及其他与季节、工作日或非办公时间相关的影响，从而改善接受静脉溶栓治疗的缺血性卒中患者的结局。
在赫尔辛基大学中心医院接受溶栓治疗的所有连续缺血性卒中患者均前瞻性登记（n=1581）。排除基底动脉闭塞患者（n=154）。使用逻辑回归模型分析门到针时间、3 个月时改良 Rankin 量表评分（0-2 分与 3-6 分）以及症状性颅内出血，模型调整了基线变量。经验丰富的定义为做出 18 次溶栓治疗决策。
门到针时间或临床结局与就诊时间或季节无关。春季（比值比 2.06，95%置信区间 1.03-4.11）和秋季（比值比 2.08，95%置信区间 1.03-4.18）症状性颅内出血的发生率较高。医师经验缩短了门到针时间（比值比 0.40，95%置信区间 0.32-0.50），但与患者结局（改良 Rankin 量表 3-6 分，比值比 1.22，95%置信区间 0.95-1.59）或症状性颅内出血（比值比 0.80，95%置信区间 0.51-1.27）发生率无关。
溶栓治疗可以在任何时候以稳定的服务水平提供。经过适当的培训，经验较少的医师可以提供高质量的溶栓治疗，但经验会转化为更快的治疗速度。
