Fu H H, Hong Y H, Shen D C, Cao Y Z, Su N, Zhai F F, Shi J Y, Zhang Z, Zhu Y C, Ni J
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100730, China.
Zhonghua Yi Xue Za Zhi. 2024 Dec 10;104(46):4240-4245. doi: 10.3760/cma.j.cn112137-20240613-01330.
To analyze the treatment situation at each time node in the standard in-hospital-stroke(IHS) in the general hospital compared with that in the emergency(community)-onset stroke (COS) group. A single-center retrospective case-control study was performed.The clinical cases of acute COS group and IHS group who were treated by the same stroke green channel team at Peking Union Medical College Hospital from Jan.2021 to Apr.2024 were included. The treatment process of acute stage of stroke was divided into four time nodes (onset, recognition, admission, and treatment), and the time of each time node was compared and analyzed. A total of 219 ischemic stroke cases were included, comprising 83 and 136 cases in IHS and COS groups, respectively. There were 134 male patients (61.2%) with a mean onset age of (66.3±15.1) years. IHS occurred across various departments, mainly in surgical departments(55/83, 66.2%). Of the perioperative IHS events, 93.7% (45/48) occurred after the surgery. Compared with the COS group, the IHS group showed a higher rate of post-waking stroke[11/32(34.4%) vs 18/136(13.2%), =0.004], a lower rate of intravenous thrombolysis[9/32 (29.0%) vs 128/136 (94.8%), 0.001], and a higher rate of mechanical thrombectomy [11/32(34.4%) vs 4/136 (2.9%), 0.001].The overall median onset-CT time in the IHS group was shorter than that in the COS group[ (, )] [100 (59, 189)min vs 135(75, 210)min, =0.030]. In different stages, median time from stroke onset to recognition[25(1, 140) vs 1(1, 30)min,=0.005] and the on-site/reception CT [30 (19, 40) min vs 16 (11, 26) min, =0.001] in the IHS group were longer than those in the COS group, while the median time from recognition to admission[30 (10, 48) min vs 76 (53, 137)min, P0.001]was shorter than that in the COS group. By using the standard ischemic stroke care system, the overall treatment time for IHS group is shorter than that of COS groups. However, compared with COS patients, the onset-recognition and admission to examination/treatment time was significantly prolonged for IHS patients, reflecting the need for further optimization of the standardized in-hospital stroke treatment process.
分析综合医院标准院内卒中（IHS）各时间节点的治疗情况，并与急诊（社区）起病卒中（COS）组进行比较。进行了一项单中心回顾性病例对照研究。纳入了2021年1月至2024年4月在北京协和医院由同一卒中绿色通道团队治疗的急性COS组和IHS组的临床病例。将卒中急性期的治疗过程分为四个时间节点（发病、识别、入院和治疗），并对每个时间节点的时间进行比较和分析。共纳入219例缺血性卒中病例，IHS组和COS组分别为83例和136例。有134例男性患者（61.2%），平均发病年龄为（66.3±15.1）岁。IHS发生于各个科室，主要在外科科室（55/83，66.2%）。围手术期IHS事件中，93.7%（45/48）发生在手术后。与COS组相比，IHS组清醒后卒中发生率更高[11/32（34.4%） vs 18/136（13.2%），P = 0.004]，静脉溶栓率更低[9/32（29.0%） vs 128/136（94.8%），P = 0.001]，机械取栓率更高[11/32（34.4%） vs 4/136（2.9%），P = 0.001]。IHS组总体发病至CT的中位时间短于COS组[（，）][100（59，189）分钟 vs 135（75，210）分钟，P = 0.030]。在不同阶段，IHS组卒中发病至识别的中位时间[25（1，140）分钟 vs 1（1，30）分钟，P = 0.005]和现场/接诊至CT的时间[30（19，40）分钟 vs 16（11，26）分钟，P = 0.001]长于COS组，而识别至入院的中位时间[30（10，48）分钟 vs 76（53，137）分钟，P<0.001]短于COS组。通过使用标准缺血性卒中护理系统，IHS组的总体治疗时间短于COS组。然而，与COS患者相比，IHS患者的发病至识别以及入院至检查/治疗时间显著延长，这反映出需要进一步优化标准化的院内卒中治疗流程。
