Amalia Lisda
Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Int J Gen Med. 2023 May 31;16:2157-2163. doi: 10.2147/IJGM.S412262. eCollection 2023.
Intravenous thrombolysis with r-tPA is the gold standard procedure in managing acute ischemic stroke recommended by the World Stroke Association, which is performed by injecting the drug r-tPA (Alteplase) intravenously. Generally, the preparation time to achieve thrombolysis is divided into pre-hospital and in-hospital. If this time can be shortened, the efficacy of thrombolysis can be increased. This study aims to determine the factors that can affect the delay in thrombolysis.
This is an analytic observational study with a retrospective cohort design in ischemic stroke confirmed by a neurologist at the neurology emergency unit of Hasan Sadikin Hospital (RSHS) from January 2021 to December 2021 and divided into two groups, delay and non-delay thrombolysis. A logistic regression test was performed to determine the independent predictor of delayed thrombolysis.
There were 141 patients with an ischemic stroke diagnosis confirmed by a neurologist at the neurological emergency unit at Hasan Sadikin Hospital (RSHS) from January 2021 to December 2021. A total of 118 (83.69%) patients were included in the "delay" category, while 23 (16.31%) patients were included in the "non-delay" category. Patients included in the "delay" category had an average age of 58.29+11.19 years with a male-to-female sex ratio of 57%, while patients included in the "non-delay" category had an average age of 55.57+15.55 years with a male-to-female sex ratio of 66%. The NIHSS admission score was a significant risk factor for delayed thrombolysis. Through multiple logistic regression, it was found that age, onset, female gender, NIHSS admission score, and NIHSS discharge score were independent predictors of delayed thrombolysis. However, all of them were not statistically significant.
Gender, risk factors for dyslipidemia, and arrival onset are independent predictors of delayed thrombolysis. Prehospital factors contribute relatively more to the delay in thrombolytic action.
使用重组组织型纤溶酶原激活剂（r-tPA）进行静脉溶栓是世界卒中协会推荐的治疗急性缺血性卒中的金标准程序，即通过静脉注射药物r-tPA（阿替普酶）来实施。一般来说，实现溶栓的准备时间分为院前和院内两个阶段。如果能缩短这段时间，溶栓效果就能提高。本研究旨在确定可能影响溶栓延迟的因素。
这是一项分析性观察研究，采用回顾性队列设计，研究对象为2021年1月至2021年12月在哈山·萨迪金医院（RSHS）神经科急诊室经神经科医生确诊的缺血性卒中患者，并分为两组，即溶栓延迟组和非延迟组。进行逻辑回归测试以确定溶栓延迟的独立预测因素。
2021年1月至2021年12月期间，哈山·萨迪金医院（RSHS）神经科急诊室有141例经神经科医生确诊为缺血性卒中的患者。共有118例（83.69%）患者被纳入“延迟”类别，而23例（16.31%）患者被纳入“非延迟”类别。纳入“延迟”类别的患者平均年龄为58.29±11.19岁，男女比例为57%，而纳入“非延迟”类别的患者平均年龄为55.57±15.55岁，男女比例为66%。美国国立卫生研究院卒中量表（NIHSS）入院评分是溶栓延迟的一个显著危险因素。通过多因素逻辑回归发现，年龄、发病时间、女性性别、NIHSS入院评分和NIHSS出院评分是溶栓延迟的独立预测因素。然而，所有这些因素均无统计学意义。
性别、血脂异常危险因素和发病时间是溶栓延迟的独立预测因素。院前因素对溶栓行动延迟的影响相对更大。
