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日本一个主要卒中核心中心急性缺血性卒中机械取栓在工作日与夜间/周末的差异。

Differences in mechanical thrombectomy for acute ischemic stroke on weekdays versus nights/ weekends in a Japanese primary stroke core center.

作者信息

Omura Naoki, Kakita Hiroto, Fukuo Yusuke, Shimizu Fuminori

机构信息

Department of Neurosurgery, Seijinkai Shimizu Hospital, Kyoto, Japan.

出版信息

J Cerebrovasc Endovasc Neurosurg. 2023 Sep;25(3):297-305. doi: 10.7461/jcen.2023.E2023.01.006. Epub 2023 Jul 11.

DOI:10.7461/jcen.2023.E2023.01.006
PMID:37433465
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10555624/
Abstract

OBJECTIVE

The term "weekend effect" refers to an increase in the mortality rate for hospitalizations occurring on weekends versus weekdays. In this study, we investigated whether such an effect exists in patients undergoing mechanical thrombectomy for acute ischemic stroke with large vessel occlusion (currently the standard treatment for this condition) at a single center in Japan.

METHODS

We surveyed 151 patients who underwent mechanical thrombectomy for acute ischemic stroke with large vessel occlusion (75 and 76 patients were treated during daytime and nighttime, respectively) from January 2019 to June 2021. The items evaluated in this analysis were the rate of modified Rankin Scale ≤2 or prestroke scale, mortality, and procedural treatment time.

RESULTS

The rates of modified Rankin Scale ≤2 or prestroke scale and mortality at 90 days after treatment did not differ significantly between daytime and nighttime (41.3% vs. 29.0%, p=0.11; 14.7% vs. 11.8%, p=0.61, respectively). The door-to-groin time tended to be shorter during daytime versus nighttime (57 [IQR: 42.5-70] min vs. 70 [IQR: 55-82]) min, p=0.0507).

CONCLUSIONS

This study did not reveal differences in treatment outcome between daytime and nighttime in patients undergoing mechanical thrombectomy for acute ischemic stroke with large vessel occlusion. Therefore, the "weekend effect" was not observed in our institution.

摘要

目的

“周末效应”一词指的是与工作日相比,周末住院患者的死亡率有所上升。在本研究中,我们调查了在日本的一个单一中心,对于急性缺血性卒中伴大血管闭塞(目前针对这种情况的标准治疗方法)接受机械取栓治疗的患者是否存在这种效应。

方法

我们调查了2019年1月至2021年6月期间151例接受急性缺血性卒中伴大血管闭塞机械取栓治疗的患者(分别有75例和76例患者在白天和夜间接受治疗)。本分析中评估的项目包括改良Rankin量表评分≤2或卒中前量表评分、死亡率和手术治疗时间。

结果

治疗后90天时,白天和夜间的改良Rankin量表评分≤2或卒中前量表评分以及死亡率无显著差异(分别为41.3%对29.0%,p = 0.11;14.7%对11.8%,p = 0.61)。白天的门到股动脉时间往往比夜间短(57 [四分位间距:42.5 - 70]分钟对70 [四分位间距:55 - 82]分钟,p = 0.0507)。

结论

本研究未发现急性缺血性卒中伴大血管闭塞接受机械取栓治疗的患者在白天和夜间的治疗结果存在差异。因此,在我们机构未观察到“周末效应”。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f935/10555624/0b87a82d4a32/jcen-2023-e2023-01-006f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f935/10555624/0b87a82d4a32/jcen-2023-e2023-01-006f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f935/10555624/0b87a82d4a32/jcen-2023-e2023-01-006f1.jpg

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Lancet. 2022 Jul 9;400(10346):116-125. doi: 10.1016/S0140-6736(22)00564-5.
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Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial.单纯取栓与静脉溶栓桥接取栓治疗脑卒中患者的效果比较:一项开放标签、盲法结局、随机非劣效性试验
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N Engl J Med. 2021 Nov 11;385(20):1833-1844. doi: 10.1056/NEJMoa2107727.
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