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| 标准卒中救治流程缩短大血管闭塞急性缺血性脑卒中患者的救治时间 |
| 朱罗江,张洪剑,沈红健,张小曦,沈芳,赵瑞,李强,张永巍,杨鹏飞*,刘建民 |
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(海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 分析长海医院标准卒中救治流程对大血管闭塞急性缺血性脑卒中（AIS）患者救治时间的影响。方法 回顾性连续选择2013年9月10日至2019年12月31日我院脑血管病中心收治的行血管内治疗的大血管闭塞AIS患者876例，排除病例资料不全者66例，最终纳入810例。按照是否采用标准卒中救治流程（2018年6月22日起实施）将患者分为研究组（采用标准卒中救治流程，335例）和对照组（未采用标准卒中救治流程，475例）。比较两组患者的入院至静脉溶栓时间（DNT）、入院至股动脉穿刺时间（DPT）、股动脉穿刺至血管再通时间（PRT），以及血管成功再通[改良脑梗死溶栓分级≥2b级]率、术后90 d预后良好[改良Rankin量表评分≤2分]率。结果 两组患者的性别、年龄及入院时美国国立卫生研究院卒中量表评分差异均无统计学意义（P均>0.05）。研究组采用静脉溶栓+血管内治疗的患者占比低于对照组[14.3%（48/335）vs 31.2%（148/475），P<0.001]。在行静脉溶栓+血管内治疗的患者中，研究组DNT、DPT、PRT均短于对照组[34.2（28.1，60.4）min vs 53.5（27.0，72.2）min、76.5（55.9，106.4）min vs 97.0（68.9，151.1）min、45.0（37.3，90.4）min vs 78.0（55.4，109.3）min]，差异均有统计学意义（P均<0.01）；研究组的术后90 d预后良好率、血管成功再通率与对照组相比[66.7%（32/48）vs 57.4%（85/148）、91.7%（44/48）vs 93.2%（138/148）]差异均无统计学意义（P均>0.05）。在直接行血管内治疗的患者中，研究组DPT、PRT也均短于对照组[67.0（50.1，109.0）min vs 87.0（60.8，150.0）min、48.0（43.5，80.8）min vs 74.0（60.3，100.6）min]，差异均有统计学意义（P均<0.001）；研究组的术后90 d预后良好率、血管成功再通率与对照组相比[54.7%（157/287）vs 52.3%（171/327）、93.0%（267/287）vs 91.1%（298/327）]差异均无统计学意义（P均>0.05）。结论 我院的标准卒中救治流程能显著缩短大血管闭塞AIS患者救治环节中的DNT、DPT和PRT，同时不影响患者的血管成功再通率与术后90 d预后良好率。 |
| 关键词: 急性缺血性脑卒中 标准卒中救治流程 血管内治疗 入院至静脉溶栓时间 入院至股动脉穿刺时间 股动脉穿刺至血管再通时间 |
| DOI：10.16781/j.0258-879x.2022.01.0023 |
| 投稿时间：2021-09-18 |
| 基金项目:上海申康医院发展中心临床研究关键支撑项目（SHDC2020CR6014），上海卫生和计划生育委员会智慧医疗专项研究项目（2018ZHYL0218） |
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| Standard stroke treatment procedures shortening treatment time for acute ischemic stroke with large vessel occlusion |
| ZHU Luo-jiang,ZHANG Hong-jian,SHEN Hong-jian,ZHANG Xiao-xi,SHEN Fang,ZHAO Rui,LI Qiang,ZHANG Yong-wei,YANG Peng-fei*,LIU Jian-min |
(Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the effect of standard stroke treatment procedures of Changhai Hospital on treatment time of patients with acute ischemic stroke (AIS) caused by large vessel occlusion.Methods A total of 876 consecutive patients with large vessel occlusion AIS who underwent endovascular treatment in Neurovascular Center of our hospital from Sep. 10, 2013 to Dec. 31, 2019 were retrospectively selected; 66 patients without complete data were excluded and 810 were finally included. The patients who received the standard stroke treatment procedures (implemented from Jun. 22, 2018) were assigned to study group (n=335), and the patients who did not received were assigned to control group (n=475). The door-to-needle time (DNT), door-to-puncture time (DPT), puncture-to-recanalization time (PRT), successful recanalization (modified thrombolysis in cerebral infarction grade ≥ 2b) rate and good prognosis (modified Rankin scale score ≤ 2) rate 90 d after operation were compared between the 2 groups.Results There were no significant differences in gender, age or National Institutes of Health stroke scale score on admission between the 2 groups (all P > 0.05). The proportion of patients treated with intravenous thrombolysis+endovascular treatment was significantly lower in the study group than that in the control group (14.3%[48/335] vs 31.2%[148/475], P < 0.001). In the patients treated with intravenous thrombolysis+endovascular treatment, the DNT, DPT and PRT were significantly shorter in the study group than those in the control group (34.2[28.1, 60.4] min vs 53.5[27.0, 72.2] min, 76.5[55.9, 106.4] min vs 97.0[68.9, 151.1] min, and 45.0[37.3, 90.4] min vs 78.0[55.4, 109.3] min, all P < 0.01). There were no significant differences in the good prognosis rate 90 d after operation or successful recanalization rate between the 2 groups (66.7%[32/48] vs 57.4%[85/148] and 91.7%[44/48] vs 93.2%[138/148], both P > 0.05). In the patients treated with endovascular treatment alone, the DPT and PRT were significantly shorter in the study group than those in the control group (67.0[50.1, 109.0] min vs 87.0[60.8, 150.0] min and 48.0[43.5, 80.8] min vs 74.0[60.3, 100.6] min, both P < 0.001). There were no significant differences in the good prognosis rate 90 d after operation or successful recanalization rate between the 2 groups (54.7%[157/287] vs 52.3%[171/327] and 93.0%[267/287] vs 91.1%[298/327], both P > 0.05).Conclusion The standard stroke treatment procedures in our hospital can significantly shorten the DNT, DPT and PRT in treating the patients with large vessel occlusion AIS, without reducing the successful recanalization rate and 90 d good prognosis rate. |
| Key words: acute ischemic stroke standard stroke treatment procedures endovascular treatment door-to-needle time door-to-puncture time puncture-to-recanalization time |
