[急诊医疗服务对接受静脉溶栓治疗的缺血性脑卒中患者预后的影响]
[Effects of emergency medical service on prognosis of ischemic stroke patients treated with intravenous thrombolysis].
作者信息
Zhong Wansi, Chen Zhicai, Chen Hongfang, Xu Dongjuan, Wang Zhimin, Hu Haifang, Wu Chenglong, Zhang Xiaoling, Ma Xiaodong, Wang Yaxian, Hu Haitao, Lou Min
机构信息
Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
Department of Neurology, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China.
出版信息
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 May 25;48(3):241-246. doi: 10.3785/j.issn.1008-9292.2019.06.02.
OBJECTIVE
To investigate the effect of emergency medical service (EMS) on the prognosis of ischemic stroke patients treated with intravenous thrombolysis.
METHODS
Clinical data of 2123 ischemic stroke patients treated with intravenous thrombolysis in 70 hospitals in Zhejiang province were retrospectively analyzed. There were 808 patients sent to the hospital by ambulance (EMS group) and 1315 patients by other transportations (non-EMS group). Good outcome was defined as modified Rankin Scale (mRS) ≤ 2 at 3-month. The onset to needle time (ONT), onset to door time (ODT), door to needle time (DNT) and outcome were compared between EMS group and non-EMS group. Binary logistic regression was used to explore the influencing factors for the outcome at 3-month.
RESULTS
Compared with the non-EMS group, patients in the EMS group were older, with higher baseline National Institute of Health Sroke Scale (NIHSS) score, and had a higher proportion of atrial fibrillation (all <0.05), but there were no significant differences in ONT, ODT and DNT between two groups (all >0.05). Binary logistic regression showed that EMS was not independently associated with good outcome (=0.856, 95%:0.664-1.103, >0.05).
CONCLUSIONS
EMS had not improve the outcome of patients receiving intravenous thrombolysis in Zhejiang province.
目的
探讨紧急医疗服务（EMS）对接受静脉溶栓治疗的缺血性脑卒中患者预后的影响。
方法
回顾性分析浙江省70家医院2123例接受静脉溶栓治疗的缺血性脑卒中患者的临床资料。其中808例由救护车送至医院（EMS组），1315例由其他交通方式送至医院（非EMS组）。良好预后定义为3个月时改良Rankin量表（mRS）评分≤2分。比较EMS组和非EMS组的从发病到穿刺时间（ONT）、从发病到入院时间（ODT）、从入院到穿刺时间（DNT）及预后情况。采用二元logistic回归分析探讨3个月时预后的影响因素。
结果
与非EMS组相比，EMS组患者年龄更大，基线美国国立卫生研究院卒中量表（NIHSS）评分更高，心房颤动比例更高（均P<0.05），但两组间ONT、ODT和DNT差异均无统计学意义（均P>0.05）。二元logistic回归分析显示，EMS与良好预后无独立相关性（P=0.856，95%CI：0.664-1.103，P>0.05）。
结论
在浙江省，EMS并未改善接受静脉溶栓治疗患者的预后。
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