印度南部一家三级医疗中心急性缺血性卒中患者院前因素对及时到达接受溶栓治疗影响的研究

摘要(中文译文)

在缺血性脑卒中患者中，院前延迟是溶栓治疗利用不足最常见的原因。本研究评估了导致研究参与者院前延迟及及时到院的院前因素。本研究在南印度Government Stanley Medical College and Hospital的急诊科开展了一项横断面研究。我们通过连续抽样选取了212名研究参与者。数据通过使用半结构化问卷访谈患者或陪同家属进行收集。先进行单因素分析，随后进行多因素logistic回归分析，以检验导致延迟和及时到院的院前因素。使用美国国立卫生研究院卒中量表（NIHSS）和美国心脏协会（AHA）-2019检查表对符合条件的研究参与者进行溶栓随访。结果发现，导致院前延迟最常见的因素是“患者/家属不了解及时到院的益处（48.7%）”，而导致及时到院最常见的因素是“担心存在某些严重健康问题（50%）”。医院与症状发作地点之间的距离、睡眠中发生卒中、转运方式、美国国立卫生研究院卒中量表（NIHSS）评分以及言语含糊被发现与及时到院接受静脉溶栓（IVT）具有显著的优势比。在按时到院的患者中（n = 60），有13名研究参与者未能接受溶栓治疗。最常见的原因是拒绝溶栓（4例，6.7%），其他标准如轻微神经功能缺损（4例，6.7%）也使其不符合溶栓条件。本研究强调了与及时到院相关的因素，以及在急性缺血性脑卒中（AIS）病例中尽管及时到院却未接受IVT的进一步原因。此外，还需要开展宣传教育，传播关于IVT益处、及时到院和院前因素的信息；提供卒中应急准备培训；并加强转诊系统，以确保最大程度的适应性和利用。

Abstract

Among ischemic stroke patients, prehospital delay is the most common reason for underutilization of thrombolysis. The study assessed prehospital factors contributing to delay and timely arrival among study participants. A cross-sectional study was carried out at the casualty department of Government Stanley Medical College and Hospital, South India. We selected 212 study participants by consecutive sampling. Data were collected by interviewing patients or accompanying family members using a semistructured questionnaire. Univariate analysis was followed by multivariate logistic regression to examine prehospital factors contributing to delay and timely arrival. Follow-up of eligible study participants for thrombolysis was performed using the National Institutes of Health Stroke Scale (NIHSS) and American Heart Association (AHA)-2019 checklist. The most common factors contributing to prehospital delay and timely arrival were found to be "unawareness regarding benefits of timely arrival among patients/relatives (48.7%)" and "apprehension of some serious health issue (50%)," respectively. The distance between the hospital and the place of onset of symptoms, stroke during sleep, mode of transport, National Institutes of Health Stroke Scale (NIHSS), and slurring of speech were found to have significant odds for timely arrival for intravenous thrombolysis (IVT). Among those who arrived on time (n = 60), 13 study participants could not undergo thrombolysis. The most common reason for this was refusal of thrombolysis (4, 6.7%), and other criteria, such as minor neurological deficits (4, 6.7%), rendered them ineligible for it. The study highlights factors associated with timely arrival at the hospital and further reasons for not undergoing IVT despite timely arrival among cases of acute ischemic stroke (AIS). There is also a need to generate awareness and disseminate information on the benefits of IVT, timely arrival, and prehospital factors; provide training in stroke preparedness; and strengthen the referral system to ensure maximum eligibility and utilization.

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