Zhong Mengqiu, Xiong Hanlin, Zhang Kebiao, Fu Shimin
Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Int J Gen Med. 2022 Mar 17;15:3069-3075. doi: 10.2147/IJGM.S349356. eCollection 2022.
Early in the pandemic, coronavirus disease 2019 (COVID-19) had been reported with significant impact on the stroke care pathway. Meanwhile, the mid/long-term consequence of treatment efficiency and effectiveness of the acute stroke pathway still remains unknown.
A comprehensive retrospective analysis was conducted on the acute stroke care pathway parameters in a stroke unit in Chongqing, Southwest China. A total of 1492 patients were involved in this study, of whom 634 patients (42.5%) were included during the COVID-19 pandemic, 858 patients (57.5%) included during the similar period of 2019. We collected demographic and clinical characteristics, clinical outcome as the treatment efficiency and effectiveness indicators of the acute stroke pathway.
Compared to the same period in 2019, there were 2.8% fewer transient ischemic attack (TIA) patients, while 9.9% more acute ischemic stroke patients in 2020. In addition, patients had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores (P = 0.002) and hospital mortality (P = 0.004) during the pandemic. The median door-CT time (P < 0.001) and emergency stay (P < 0.001) of acute stroke were also remarkably increased during the pandemic. The proportion of patients with intravenous thrombolysis (IVT) was significantly lower (P < 0.001), while the mechanical thrombectomy (MET) was remarkably higher (P = 0.042) in the pandemic group. Moreover, the IVT was significantly delayed during the pandemic (door-needle time: P = 0.001).
The COVID-19 outbreak did not reduce the willingness of the acute stroke patient to seek medical help. Benefited from adjustments of stroke procedure in response to the COVID-19 pandemic, no significant reduction was observed in the reperfusion success of the acute stroke care pathway. However, more medical resources need to be invested into the acute stroke care pathway to prevent serious consequences of undiagnosed and untreated strokes.
在疫情早期，有报道称2019冠状病毒病（COVID-19）对卒中治疗路径产生了重大影响。与此同时，急性卒中治疗路径的治疗效率和效果的中长期后果仍然未知。
对中国西南部重庆某卒中单元的急性卒中治疗路径参数进行了全面的回顾性分析。本研究共纳入1492例患者，其中634例患者（42.5%）在COVID-19大流行期间纳入，858例患者（57.5%）在2019年同期纳入。我们收集了人口统计学和临床特征、临床结局作为急性卒中治疗路径的治疗效率和效果指标。
与2019年同期相比，2020年短暂性脑缺血发作（TIA）患者减少2.8%，而急性缺血性卒中患者增加9.9%。此外，在大流行期间，患者的美国国立卫生研究院卒中量表（NIHSS）评分（P = 0.002）和医院死亡率（P = 0.004）显著更高。急性卒中的中位门-CT时间（P < 0.001）和急诊停留时间（P < 0.001）在大流行期间也显著增加。大流行组静脉溶栓（IVT）患者比例显著降低（P < 0.001），而机械取栓（MET）显著更高（P = 0.042）。此外，大流行期间IVT明显延迟（门-针时间：P = 0.001）。
COVID-19疫情并未降低急性卒中患者寻求医疗帮助 的意愿。受益于针对COVID-19疫情对卒中流程的调整，急性卒中治疗路径的再灌注成功率未观察到显著降低。然而，需要在急性卒中治疗路径中投入更多医疗资源，以防止未诊断和未治疗卒中的严重后果。
