Wang Yaohui, Zhang Chongyang, Sun Wei, Hu Xiaodong, Lyu Zhe, Liu Weibin
Department of Emergency, the First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei, China (Wang YH, Zhang CY, Sun W, Lyu Z, Liu WB); Department of Emergency, Changli County People's Hospital, Qinhuangdao 066600, Hebei, China (Hu XD). Corresponding author: Zhang Chongyang, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jul;30(7):667-670. doi: 10.3760/cma.j.issn.2095-4352.2018.07.010.
To investigate the prehospital intervention based on emergency medical services (EMS) in patients with acute ischemic stroke (AIS) for door-to-needle time (DNT) with intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) impact.
112 emergency patients receiving rt-PA intravenous thrombolysis admitted to the First Hospital of Qinhuangdao City based on EMS from June 2016 to December 2017 were enrolled. According to whether or not to receive prehospital interventions, patients were divided into prehospital intervention group (n = 42) and routine treatment group (n = 70). Both groups followed the general principles of first aid, including assessment and support of the airway, respiration, and circulation, and blood glucose, electrocardiogram, and dynamic vital signs were monitored. Based on the general principle of EMS, first-aid personnel in the prehospital intervention group screened suspected acute stroke patients requiring prehospitalization according to Los Angeles prehospital stroke screening table (LAPSS), and established fluid ways, and got blood samples to evaluate rt-PA intravenous thrombolysis and risks. Factors influenced DNT compliance were analyzed through multivariate Logistic regression, which included the education level of the patient, whether there were risk factors related to cerebrovascular disease (hypertension, coronary heart disease, diabetes), visit time, National Institute of Health stroke scale (NIHSS) score, whether received EMS intervention or not. The average DNT, DNT ≤ 60 minutes compliance rate, communication time, and decision time for thrombolysis were compared between the two groups. NIHSS score was used to evaluate the effective rate of thrombolysis for 7 days. The modified Rankin score (mRs) was used to evaluate the neurological function after 3 months of thrombolysis (a mRs score of 0-2 was defined as a good nerve function).
Univariate analysis showed that the DNT of patients with NIHSS score > 5 was significantly shorter than those with NIHSS score ≤ 5, and DNT in patients received EMS intervention was significantly shorter than the non-receiver; but education level, visiting time, and risk factors associated with cerebrovascular disease had nothing to do with DNT. Multivariate Logistic regression analysis showed that NIHSS score and EMS intervention were the influencing factors of DNT compliance [NIHSS score: odds ratio (OR) = 0.452, 95% confidence interval (95%CI) = 0.162-1.263, P = 0.030; EMS intervention: OR = 3.077, 95%CI = 1.260-7.514, P = 0.014]. Compared with conventional treatment group, DNT of intravenous thrombolytic in prehospital intervention group was significantly shortened (minutes: 62.00±11.07 vs. 78.03±21.04), DNT ≤ 60 minutes compliance rate was significantly increased [35.7% (15/42) vs. 12.9% (9/70)], communication time [minutes: 4 (3, 6) vs. 6 (5, 9)] and decision-making thrombolytic time (minutes: 5.81±2.48 vs. 6.70±2.15) were significantly shortened, the differences were statistically significant (all P < 0.05). The 7-day effective rate in the prehospital intervention group [33.3% (14/42) vs. 14.3% (10/70), χ = 5.657, P = 0.017] and the 3-mouth good rate of nerve function [38.1% (16/42) vs. 14.3% (10/70), χ = 10.759, P = 0.001] were significantly higher than those in the conventional treatment group.
Prehospital interventions based on EMS can shorten DNT of intravenous thrombolysis in the patients with AIS, improve treatment efficiency, and improve prognosis.
探讨基于急诊医疗服务（EMS）的院前干预对急性缺血性脑卒中（AIS）患者静脉注射重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗的门-针时间（DNT）的影响。
选取2016年6月至2017年12月在秦皇岛市第一医院基于EMS接受rt-PA静脉溶栓治疗的112例急诊患者。根据是否接受院前干预，将患者分为院前干预组（n = 42）和常规治疗组（n = 70）。两组均遵循急救的一般原则，包括气道、呼吸和循环的评估与支持，并监测血糖、心电图和动态生命体征。基于EMS的一般原则，院前干预组的急救人员根据洛杉矶院前卒中筛查表（LAPSS）筛查疑似需要院前治疗的急性卒中患者，建立静脉通路，采集血样以评估rt-PA静脉溶栓及风险。通过多因素Logistic回归分析影响DNT依从性的因素，包括患者的教育程度、是否存在脑血管疾病相关危险因素（高血压、冠心病、糖尿病）、就诊时间、美国国立卫生研究院卒中量表（NIHSS）评分、是否接受EMS干预等。比较两组的平均DNT、DNT≤60分钟的依从率、沟通时间和溶栓决策时间。采用NIHSS评分评估溶栓7天的有效率。采用改良Rankin量表（mRs）评估溶栓3个月后的神经功能（mRs评分为0-2定义为神经功能良好）。
单因素分析显示，NIHSS评分>5分的患者DNT显著短于NIHSS评分≤5分的患者，接受EMS干预的患者DNT显著短于未接受者；但教育程度、就诊时间和脑血管疾病相关危险因素与DNT无关。多因素Logistic回归分析显示，NIHSS评分和EMS干预是DNT依从性的影响因素[NIHSS评分：比值比（OR）=0.452，95%置信区间（95%CI）=0.162-1.263，P = 0.030；EMS干预：OR = 3.077，95%CI = 1.260-7.514，P = 0.014]。与常规治疗组相比，院前干预组静脉溶栓的DNT显著缩短（分钟：62.00±11.07 vs. 78.03±21.04），DNT≤60分钟的依从率显著提高[35.7%（15/42）vs. 12.9%（9/70）]，沟通时间[分钟：4（3，6）vs. 6（5，9）]和溶栓决策时间（分钟：5.81±2.48 vs. 6.70±2.15）显著缩短，差异均有统计学意义（均P < 0.05）。院前干预组的7天有效率[33.3%（14/42）vs. 14.3%（10/70），χ² = 5.657，P = 0.017]和3个月神经功能良好率[38.1%（16/42）vs. 14.3%（10/70），χ² = 10.759，P = 0.001]均显著高于常规治疗组。
基于EMS的院前干预可缩短AIS患者静脉溶栓的DNT，提高治疗效率，改善预后。
