[急性缺血性卒中静脉溶栓治疗门针时间的决定因素]

[Determinants of door to needle time for intravenous thrombolysis in acute ischemic stroke].

作者信息

Brunser Alejandro M, Mazzon Enrico, Muñoz Paula, Hoppe Arnold, Lavados Pablo M, Rojo Alexis, Navia Víctor, Cavada Gabriel, Olavarría Verónica V, Mansilla Eloy

机构信息

Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.

Departamento Científico Docente, Clínica Alemana de Santiago, Unidad de Investigación y Ensayos Clínicos, Santiago, Chile.

出版信息

Rev Med Chil. 2020 Aug;148(8):1090-1095. doi: 10.4067/S0034-98872020000801090.

DOI:10.4067/S0034-98872020000801090

PMID:33399775

Abstract

BACKGROUND

Intravenous thrombolysis (IT) in acute ischemic stroke (AIS) is time dependent. The time elapsed from hospital admission to the thrombolytic bolus is named door to needle time (DNT) and is recommend to be of less than 60 min.

AIM

To describe the DNT in our center and determine those factors associated with a DNT longer than 60 min.

MATERIAL AND METHODS

Prospective analysis of patients treated with IT at a private hospital between June 2016 and June 2019. The percentage of patients with DNT exceeding 60 min, and the causes for this delay were evaluated.

RESULTS

IT was used in 205 patients. DNT was 43.6 ± 23.8 min. Forty patients (19.5% (95% CI, 14.4-25.7), had a DNT longer than 60 min. Uni-varied analysis demonstrated that AIS with infratentorial symptomatology (ITS), was significantly associated with DNTs exceeding 60 min. A history of hypertension, a higher NIH Stroke Scale score, the presence of an hyperdense sign in brain tomography (p = 0.001) and the need for endovascular therapy (p = 0.019), were associated with DNT shorter than 60 min. Multivariate analysis ratified the relationship between ITS and DNT longer than 60 min (Odds ratio: 3.19, 95% confidence intervals 1.26-8).

CONCLUSIONS

The individual elements that correlated with a DNT longer than 60 min were the failure to detect the AIS during triage and doubts about its diagnosis.

摘要

背景

急性缺血性卒中（AIS）的静脉溶栓治疗具有时间依赖性。从入院到溶栓推注所经过的时间称为门到针时间（DNT），建议该时间小于60分钟。

目的

描述我们中心的DNT，并确定与DNT超过60分钟相关的因素。

材料与方法

对2016年6月至2019年6月在一家私立医院接受静脉溶栓治疗的患者进行前瞻性分析。评估DNT超过60分钟的患者百分比及其延迟原因。

结果

205例患者接受了静脉溶栓治疗。DNT为43.6±23.8分钟。40例患者（19.5%（95%CI，14.4 - 25.7））的DNT超过60分钟。单因素分析表明，幕下症状性AIS（ITS）与DNT超过60分钟显著相关。高血压病史、较高的美国国立卫生研究院卒中量表评分、脑断层扫描中出现高密度征（p = 0.001）以及需要血管内治疗（p = 0.019）与DNT短于60分钟相关。多因素分析证实了ITS与DNT超过60分钟之间的关系（比值比：3.19，95%置信区间1.26 - 8）。