Fang Kun, Churilov Leonid, Weir Louise, Dong Qiang, Davis Stephen, Yan Bernard
Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Department of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia; Department of Neurology, Florey Neuroscience Institutes, Melbourne, Victoria, Australia.
J Stroke Cerebrovasc Dis. 2014 Mar;23(3):427-32. doi: 10.1016/j.jstrokecerebrovasdis.2013.03.029. Epub 2013 Apr 28.
Previous studies on the impact of nonworking hours (NWH) have produced conflicting results. We aimed to compare the time to treatment with thrombolysis between NWH and working hours (WH) at an Australian comprehensive stroke center.
All acute ischemic stroke patients treated with intravenous alteplase (IV-alteplase) from January 2003 to December 2011 at the Royal Melbourne Hospital were included. Data collected included demographics, serial time points (including onset, presentation to emergency department, neuroimaging, and thrombolysis), and clinical outcomes (modified Rankin Scale [mRS] and death) at 3 months. NWH were defined as weekdays 5 PM-8 AM, weekends, and public holidays. Comparisons were made in the door-to-computed tomography (CT) time, the door-to-needle time, mRS, and mortality within 3 months between the NWH group and WH group.
We recruited 388 consecutive patients who received IV-alteplase, 226 patients were in NWH and 162 patients in WH. The median age was 71 years (Interquartile range [IQR] = 60-79), 54.1% of patients were male, and the median National Institutes of Health Stroke Scale score was 13 (IQR = 8-18). No significant differences were observed at baseline between the NWH and WH groups except for prior stroke. There was a 15-minute increase in the median door-to-needle time (80 minutes in the NWH group versus 64.5 minutes in the WH group, 95% confidence interval [CI]: 6.36-23.64, P = .001). No significant differences were noted in the median door-to-CT time (95% CI: -1.16 to 9.16, P = .128) and clinical outcomes at 3 months (P > .05). Both the door-to-CT time and the door-to-needle time became shorter over the period of the study (P < .001).
Our study showed that the "NWH effect" increased the door-to-needle time. The patients treated out of hours did not have a worse outcome.
以往关于非工作时间（NWH）影响的研究结果相互矛盾。我们旨在比较澳大利亚一家综合性卒中中心非工作时间与工作时间（WH）内进行溶栓治疗的时间。
纳入2003年1月至2011年12月在皇家墨尔本医院接受静脉注射阿替普酶（IV-阿替普酶）治疗的所有急性缺血性卒中患者。收集的数据包括人口统计学信息、连续时间点（包括发病时间、到急诊科就诊时间、神经影像学检查时间和溶栓时间）以及3个月时的临床结局（改良Rankin量表[mRS]评分和死亡情况）。非工作时间定义为工作日下午5点至上午8点、周末及公共假日。比较了非工作时间组和工作时间组在门到计算机断层扫描（CT）时间、门到针时间、mRS评分以及3个月内死亡率方面的差异。
我们连续招募了388例接受IV-阿替普酶治疗的患者，其中226例在非工作时间接受治疗，162例在工作时间接受治疗。中位年龄为71岁（四分位间距[IQR]=60 - 79），54.1%的患者为男性，美国国立卫生研究院卒中量表中位评分为13分（IQR = 8 - 18）。除既往有卒中史外，非工作时间组和工作时间组在基线时未观察到显著差异。中位门到针时间增加了15分钟（非工作时间组为80分钟，工作时间组为64.5分钟，95%置信区间[CI]：6.36 - 23.64，P = .001）。门到CT时间中位数（95%CI：-1.16至9.16，P = .128）和3个月时的临床结局（P > .05）未观察到显著差异。在研究期间，门到CT时间和门到针时间均缩短（P < .001）。
我们的研究表明，“非工作时间效应”增加了门到针时间。非工作时间接受治疗的患者结局并不更差。
