Acampa Maurizio, Peresso Valentina, Lazzerini Pietro Enea, Domenichelli Carlo, Guideri Francesca, Tassi Rossana, Dami Stefano, Marconi Roberto, Iannelli Giovanni, Linoli Giovanni, Peppoloni Giulia, Nocentini Simone, Gallerini Simone, Cartocci Alessandra, Bracco Sandra, Martini Giuseppe
Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General-Hospital, Siena, Italy.
Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy.
Cardiovasc Hematol Disord Drug Targets. 2021;21(3):179-184. doi: 10.2174/1871529X21666210927094058.
During Covid-19 pandemic, the Italian National Healthcare Service has faced increasing pressure, especially in Northern Italy. Even in less-affected regions, such as Tuscany, the changes in the healthcare system to prevent Covid-19 spread resulted in difficulty in treating time-dependent disorders like ischemic stroke rapidly.
The aim of our study was to assess the outcome after acute ischemic stroke treatments during the Covid-19 spread in comparison with a similar period of the previous year in Siena-Hospital (Hub center in the South-East Tuscany).
We enrolled all patients admitted to Siena-Hospital for ischemic stroke and submitted them to acute treatments (intravenous and/or mechanical thrombolysis) between February 21st and May 18th, 2020 (study group, n:38) and compared the results with ischemic strokes acutely treated in a similar period in 2019 (control group, n:39). The modified Rankin scale score was assessed at 90 days to evaluate a 3-month clinical outcome.
In the study group, the time from symptoms onset to hospital arrival and the door-to-groin puncture time were significantly more prolonged than in the control group. In moderate-severe strokes, the 3-month mortality was significantly higher in the study group (31% vs. 6%; p=0.01), and the number of patients with poor functional outcomes was significantly higher in the study group (73% vs. 44%; p=0.03).
During the lockdown period due to Covid-19 pandemic, patients with acute ischemic stroke had a worse prognosis. These findings suggest the need to improve the health system organization to guarantee an appropriate treatment during the pandemic, including the patients that are not affected by Covid-19.
在新冠疫情期间，意大利国家医疗服务体系面临着越来越大的压力，尤其是在意大利北部。即使在受影响较小的地区，如托斯卡纳，为防止新冠病毒传播而对医疗系统进行的调整，也导致难以迅速治疗诸如缺血性中风等时间依赖性疾病。
我们研究的目的是评估在新冠疫情传播期间，与锡耶纳医院（托斯卡纳东南部的中心医院）上一年同期相比，急性缺血性中风治疗后的结果。
我们纳入了所有因缺血性中风入住锡耶纳医院并在2020年2月21日至5月18日期间接受急性治疗（静脉和/或机械溶栓）的患者（研究组，n = 38），并将结果与2019年同期接受急性治疗的缺血性中风患者（对照组，n = 39）进行比较。在90天时评估改良Rankin量表评分，以评估3个月的临床结果。
研究组中，从症状发作到入院的时间以及从入院到股动脉穿刺的时间比对照组显著延长。在中重度中风中，研究组的3个月死亡率显著更高（31%对6%；p = 0.01），功能预后不良的患者数量在研究组中也显著更高（73%对44%；p = 0.03）。
在新冠疫情导致的封锁期间，急性缺血性中风患者的预后较差。这些发现表明需要改善卫生系统的组织，以在疫情期间保证适当的治疗，包括未受新冠病毒影响的患者。
