运用院前通知程序缩短静脉溶栓患者发病至溶栓时间的研究

A study on shortening of onset-to-needle time in patients receiving intravenous thrombolysis using pre-hospital notification procedure

摘要:

目的 探讨运用120转运联合院前通知程序是否可以缩短接受重组人组织型纤溶酶原激活剂（rt-PA）静脉溶栓患者的发病至溶栓时间（ONT）并改善预后。方法 回顾性地收集2018年1月至2018年6月在广西河池市人民医院接受静脉rt-PA溶栓的急性缺血性卒中患者的数据，分为自行转运无院前通知组和120转运联合院前通知组。比较两组患者ONT、入院到溶栓时间（DNT）及第90天mRS评分≤ 2分的比例。结果 共纳入57例患者，27例（47.4%）使用120转运联合院前通知程序，30例（52.6%）自行转运无院前通知。两组相比，120转运联合院前通知程序组显示出更短的中位ONT（116 min vs 190 min），两组之间差异有统计学意义（P=0.009）。两组mRS评分≤ 2分比例比较，120转运联合院前通知组获得mRS评分≤ 2分比例明显更高（56.7% vs 88.9%），差异具有统计学意义（P=0.007）。在调整了年龄，性别，基线NIHSS评分的回归分析模型中，提示使用120转运联合院前通知程序可大幅度缩短ONT 76.3分钟（95%CI，36.4~116.3；P<0.001）。结论 运用120转运联合院前通知程序可显著缩短rt-PA静脉溶栓患者的ONT，并改善静脉溶栓患者预后。

Abstract:

Objective To investigate whether the adoption of 120 transfer (an emergency medical service in China) combined with pre-hospital notification procedure can shorten the onset-to-needle time (ONT) and improve the prognosis of patients receiving intravenous thrombolysis with recombinant human tissue plasminogen activator (rt-PA). Methods Data were retrospectively collected from patients with acute ischemic stroke who had received intravenous thrombolysis with rt-PA from January to June, 2018 in the People's Hospital of Hechi, Guangxi Zhuang Autonomous Region, China; the patients were divided into self-arranged transfer without pre-hospital notification group (group A) and 120 transfer combined with pre-hospital notification procedure group (group B). The two groups were compared for ONT, door-to-needle time, and proportion of patients with modified Rankin Scale (mRS) score ≤ 2 on day 90. Results Among the 57 patients enrolled in the study, 27 (47.4%) adopted 120 transfer combined with pre-hospital notification procedure, and 30 (52.6%) adopted self-arranged transfer without pre-hospital notification. Compared with group A, group B had a significantly shorter median ONT (190 minutes vs 116 minutes, P=0.009) and a significantly higher proportion of patients with mRS score ≤ 2 (56.7% vs 88.9%, P=0.007). A regression analysis using a model adjusted for age, sex, and baseline NIHSS score indicated that the adoption of 120 transfer combined with pre-hospital notification procedure significantly shortened ONT by 76.3 minutes (95% confidence interval:36.4-116.3, P<0.001). Conclusions The adoption of 120 transfer combined with pre-hospital notification procedure can significantly shorten the ONT and improve the prognosis of patients receiving intravenous thrombolysis with rt-PA.