Journal of Hebei Medical University ›› 2022, Vol. 43 ›› Issue (5): 512-516.doi: 10.3969/j.issn.1007-3205.2022.05.003

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Effect of prehospital emergency system on duration of thrombolysis in patients with acute ischemic stroke and its influencing factors

  

  1. 1.Department of General Practice， Shanghai Tongji University School of Medicine， Shanghai 200092,

    China; 2.Department of Neurology, Central Hospital of Jiading District, Shanghai 200092,China;

    3.Department of Neurology, Yangpu Hospital Affiliated to Shanghai Tongji University，

    Shanghai 200092, China; 4.Department of Emergency, Medical Emergency Center of Jiading District， Shanghai 200092, China

  • Online:2022-05-25 Published:2022-05-30

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Abstract:

Objective  To explore the efficacy of prehospital emergency system in duration of thrombolysis for patients with acute ischemic stroke(AIS), and to analyze the influencing factors of arrival by ambulance.

Methods  A retrospective analysis was made on the stroke patients undergoing thrombolytic therapy in Emergency Department. The patients were divided into arrival by ambulance group(n=86) and self-visiting group(n=138) according to their method of visiting the hospital. The basic information(gender,age,marital status,and medical insurance payments) and the risk factors for previous stroke［hypertension,diabetes,coronary heart disease(CHD),dyslipidemia,history of cardiac valvular disease,atrial fibrillation(AF),and stroke)］, the symptoms at onset(limb weakness/weakness,slurred speech,visual disturbances,gaze,dizziness,headache,disturbance of consciousness), blood pressure at admission,heart rate,blood glucose,National Institute of Health Stroke Scale(NHISS) score,primary outcome［onset to needle time(ONT)］, secondary outcomes［onset to door time(ODT), onset to CT time(OCT),door to CT time(DCT), door to needle time(DNT) ］ betweem two groups, and the influencing factors of arrival by ambulance were analyzed.

Results  There were significant differences in the two groups with respect to history of AF,limbweakness/weakness,slurred speech,visual disturbances,gaze,dizziness,presence of multiple symptoms(≥4 symptoms),ODT,OCT,ONT and NHISS scores before thrombolysis(P＜0.05). There were no significant differences in the two groups with respect to gender,age,household register,marital status,use of medical insurance payments, hypertension,diabetes, hyperlipidemia,CHD,cardiac valvular disease,stroke history,smoking history,drinking history,dizziness and headache,systolic blood pressure,diastolic blood pressure,heart rate,blood glucose,DCT and DNT(P＞0.05). Multivariate Logistic regression analysis showed AF(95%CI: 0.127-0.834, P＜0.05),limb weakness/weakness(95%CI: 0.018-0.399, P＜0.05),and slurred speech(95%CI: 0.117-0.924, P＜0.05) were protective factors for arrival by ambulance in patients with ischemic stroke.

Conclusion  Arrivial by ambulance for stroke patients can significantly shorten ONT. For patients at risk of stroke, daily chronic disease management and health education should be strengthened, and ideas should be further clarified to optimize the established stroke treatment network process.

Key words: stroke; emergency medical services, thrombolysis