中国湖北急性缺血性脑卒中的静脉溶栓治疗：溶栓率及障碍调查。
Intravenous thrombolytic therapy for acute ischemic stroke in Hubei, China: a survey of thrombolysis rate and barriers.
机构信息
Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
School of Public Health, Hainan Medical University, Haikou, 571199, People's Republic of China.
出版信息
BMC Neurol. 2019 Aug 22;19(1):202. doi: 10.1186/s12883-019-1418-z.
BACKGROUND
Rates of thrombolysis in most countries are well below best practice benchmarks. We aimed to investigate thrombolysis utilization and its associated factors in acute ischemic stroke (AIS) patients in Hubei province, China, to assess neurologists' experiences of the treatment, and to identify barriers against the treatment from perspective of AIS patients and neurologists.
METHODS
Survey of 2096 AIS patients and 709 neurologists from 66 hospitals was conducted in Hubei province between 2014 and 2015. A multivariable logistic regression model was utilized to identify the factors associated with thrombolysis utilization and neurologists' experiences with thrombolysis.
RESULTS
Of the 2096 AIS patients, only 3.8% received thrombolysis. Of the 709 neurologists, 66.0% reported using thrombolysis for AIS patients. The main reasons for not using thrombolysis were late arrival of patients, fear of the risk of complications of thrombolysis, and light or quickly recovered stroke symptoms. The behavior and clinical characteristics of patients, including early admission to hospital (odds ratio [OR] = 5.81, 95% confidence intervals [CI] 3.31-10.20), using emergency medical services to be hospitalized (OR = 3.36, 95% CI 2.00-5.62), stroke history (OR = 0.53, 95% CI 0.28-0.99), and National Institute of Health Stroke Scale score < 4 (OR = 0.46, 95% CI 0.27-0.77) were shown to significantly affect the thrombolysis utilization in the multivariate model. In addition, hospital grade (OR = 2.84, 95% CI 1.84-4.37), education level (OR = 2.49, 95% CI 1.09-5.73), and working years (OR = 1.88, 95% CI 1.18-3.00) were strongly associated with neurologists' experiences of thrombolysis.
CONCLUSIONS
A very low proportion of AIS patients received thrombolysis in Hubei province, China. Considerable education programs and interventions were required regarding knowledge of stroke treatment for clinicians and proper behavior after stroke for AIS patients and their families.
背景
大多数国家的溶栓治疗率远低于最佳实践标准。我们旨在调查中国湖北省急性缺血性脑卒中（AIS）患者的溶栓治疗利用情况及其相关因素，评估神经科医生对治疗的经验，并从 AIS 患者和神经科医生的角度确定治疗的障碍。
方法
2014 年至 2015 年，在湖北省对 66 家医院的 2096 名 AIS 患者和 709 名神经科医生进行了调查。利用多变量逻辑回归模型确定与溶栓治疗利用相关的因素和神经科医生使用溶栓治疗的经验。
结果
在 2096 名 AIS 患者中，只有 3.8%接受了溶栓治疗。在 709 名神经科医生中，66.0%的人报告对 AIS 患者使用了溶栓治疗。不使用溶栓治疗的主要原因是患者到达较晚、担心溶栓治疗并发症的风险以及中风症状较轻或很快恢复。患者的行为和临床特征，包括早期住院（优势比[OR] = 5.81，95%置信区间[CI] 3.31-10.20）、使用紧急医疗服务住院（OR = 3.36，95%CI 2.00-5.62）、中风史（OR = 0.53，95%CI 0.28-0.99）和美国国立卫生研究院卒中量表评分<4（OR = 0.46，95%CI 0.27-0.77），在多变量模型中显著影响溶栓治疗的利用。此外，医院级别（OR = 2.84，95%CI 1.84-4.37）、教育程度（OR = 2.49，95%CI 1.09-5.73）和工作年限（OR = 1.88，95%CI 1.18-3.00）与神经科医生使用溶栓治疗的经验密切相关。
结论
在中国湖北省，只有极少数 AIS 患者接受溶栓治疗。需要对临床医生的中风治疗知识和 AIS 患者及其家属中风后的适当行为进行大量教育计划和干预。
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