COVID-19 大流行期间的急性脑卒中护理：老年患者入院人数减少，院前延误增加。
Acute Stroke Care during the COVID-19 Pandemic: Reduction in the Number of Admissions of Elderly Patients and Increase in Prehospital Delays.
机构信息
Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain,
Department of Neurology, Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
出版信息
Cerebrovasc Dis. 2021;50(3):310-316. doi: 10.1159/000514140. Epub 2021 Mar 17.
INTRODUCTION
We analyzed whether the coronavirus disease 2019 (COVID-19) crisis affected acute stroke care in our center during the first 2 months of lockdown in Spain.
METHODS
This is a single-center, retrospective study. We collected demographic, clinical, and radiological data; time course; and treatment of patients meeting the stroke unit admission criteria from March 14 to May 14, 2020 (COVID-19 period group). Data were compared with the same period in 2019 (pre-COVID-19 period group).
RESULTS
195 patients were analyzed; 83 in the COVID-19 period group, resulting in a 26% decline of acute strokes and transient ischemic attacks (TIAs) admitted to our center compared with the previous year (p = 0.038). Ten patients (12%) tested positive for PCR SARS-CoV-2. The proportion of patients aged 65 years and over was lower in the COVID-19 period group (53 vs. 68.8%, p = 0.025). During the pandemic period, analyzed patients were more frequently smokers (27.7 vs. 10.7%, p = 0.002) and had less frequently history of prior stroke (13.3 vs. 25%, p = 0.043) or atrial fibrillation (9.6 vs. 25%, p = 0.006). ASPECTS score was lower (9 [7-10] vs. 10 [8-10], p = 0.032), NIHSS score was slightly higher (5 [2-14] vs. 4 [2-8], p = 0.122), onset-to-door time was higher (304 [93-760] vs. 197 [91.25-645] min, p = 0.104), and a lower proportion arrived within 4.5 h from onset of symptoms (43.4 vs. 58%, p = 0.043) during the CO-VID-19 period. There were no differences between proportion of patients receiving recanalization treatment (intravenous thrombolysis and/or mechanical thrombectomy) and in-hospital delays.
CONCLUSION
We observed a reduction in the number of acute strokes and TIAs admitted during the COVID-19 period. This drop affected especially elderly patients, and despite a delay in their arrival to the emergency department, the proportion of patients treated with recanalization therapies was preserved.
介绍
本研究旨在分析 2020 年西班牙封锁期间，新冠疫情是否对本中心的急性脑卒中治疗产生影响。
方法
这是一项单中心回顾性研究。我们收集了 2020 年 3 月 14 日至 5 月 14 日（新冠疫情期间）和 2019 年同期（新冠疫情前）符合卒中单元入院标准的患者的人口统计学、临床和影像学数据、发病时间和治疗情况。
结果
共分析了 195 例患者，其中 83 例为新冠疫情期间入院，与前一年相比，我院收治的急性脑卒中及短暂性脑缺血发作患者减少了 26%（p=0.038）。10 例（12%）患者 PCR SARS-CoV-2 检测结果为阳性。与新冠疫情前相比，新冠疫情期间患者的年龄在 65 岁及以上的比例更低（53%比 68.8%，p=0.025）。在疫情期间，分析患者更频繁地吸烟（27.7%比 10.7%，p=0.002），且既往有脑卒中史（13.3%比 25%，p=0.043）和心房颤动史（9.6%比 25%，p=0.006）的比例更低。ASPECTS 评分较低（9[7-10]比 10[8-10]，p=0.032），NIHSS 评分略高（5[2-14]比 4[2-8]，p=0.122），发病至到院时间较长（304[93-760]比 197[91.25-645]min，p=0.104），且发病后 4.5 小时内到院的比例较低（43.4%比 58%，p=0.043）。新冠疫情期间，接受血管内溶栓和/或机械取栓治疗的患者比例和院内延误时间无差异。
结论
我们观察到新冠疫情期间急性脑卒中及短暂性脑缺血发作患者入院人数减少。这种下降尤其影响了老年患者，尽管他们到急诊科的时间延迟，但接受血管再通治疗的患者比例仍保持不变。
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