中国 COVID-19 大流行期间的延误性脑卒中治疗。
Delayed Stroke Treatment during COVID-19 Pandemic in China.
机构信息
Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China.
Department of Neurology, Affiliated Yixing Hospital of Jiangsu University, Yixing, China.
出版信息
Cerebrovasc Dis. 2021;50(6):715-721. doi: 10.1159/000517075. Epub 2021 Jul 9.
BACKGROUND
Social distance, quarantine, pathogen testing, and other preventive strategies implemented during CO-VID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS).
OBJECTIVE
The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of AIS in China.
METHODS
This study included patients with AIS admitted in 2 hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 pandemic outbreak (January 31, 2020, as officially announced by the Chinese government) were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and compared for pre- (measured as onset-to-door time [ODT]) and posthospital delay (measured as door-to-needle time [DNT]). The influencing factors for delayed treatment (indicated as onset-to-needle time >4.5 h) were analyzed with multivariate logistic regression analysis.
RESULTS
A total of 252 patients were included, of which 153 (60.7%) were enrolled before and 99 (39.3%) after the COVID-19 pandemic. ODT increased from 202 min (interquartile range [IQR] 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (p = 0.001). DNT increased from 50 min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (p = 0.048). The proportion of patients with intravenous thrombolysis in those with AIS was decreased significantly after the pandemic (15.4% vs. 20.1%; p = 0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms, small artery occlusion, and transported by other means than ambulance were associated with delayed treatment.
CONCLUSIONS
COVID-19 pandemic has remarkable impacts on the management of AIS. Both pre- and posthospital delays were prolonged significantly, and proportion of patients arrived within the 4.5-h time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.
背景
在 COVID-19 大流行期间实施的社交距离、隔离、病原体检测和其他预防策略可能会对急性缺血性脑卒中（AIS）的管理产生负面影响。
目的
本研究旨在评估 COVID-19 大流行对中国 AIS 治疗延迟的影响。
方法
本研究纳入了江苏省 2 家医院收治的 AIS 患者。筛选出 COVID-19 大流行爆发前（2020 年 1 月 31 日，中国政府正式宣布）和大流行爆发后（2020 年 1 月 31 日，中国政府正式宣布）入院的患者，收集人口统计学数据、病史信息和临床病历中的症状发作情况，并进行比较，以评估入院前（测量为发病至入院时间[ODT]）和入院后（测量为入院至溶栓时间[DNT]）的延迟。采用多变量 logistic 回归分析影响治疗延迟的因素（表示为发病至溶栓时间＞4.5 h）。
结果
共纳入 252 例患者，其中 153 例（60.7%）在 COVID-19 大流行前，99 例（39.3%）在 COVID-19 大流行后。ODT 从 COVID-19 大流行前的 202 分钟（IQR 65-492）增加到 COVID-19 大流行后的 317 分钟（IQR 75-790）（p = 0.001）。DNT 从 COVID-19 大流行前的 50 分钟（IQR 40-75）增加到 COVID-19 大流行后的 65 分钟（IQR 48-84）（p = 0.048）。大流行后 AIS 患者静脉溶栓治疗的比例显著下降（15.4% vs. 20.1%；p = 0.030）。多变量 logistic 回归分析表明，COVID-19 大流行后、文化程度较低、农村居住、症状较轻、小动脉闭塞、非救护车转运的患者与治疗延迟有关。
结论
COVID-19 大流行对 AIS 的管理产生了显著影响。入院前和入院后延迟均显著延长，且在 4.5 h 时间窗内接受静脉溶栓治疗的患者比例下降。鉴于抗 COVID-19 措施已成为常规医疗措施，有必要努力缩短延迟时间，以改善脑卒中患者的预后。
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