中国卒中杂志2018，Vol.13Issue(2)：114-121,8.DOI:10.3969/j.issn.1673-5765.2018.02.004
院前预通知流程改善急性缺血性卒中患者血管内治疗的预后
Prehospital Notification Procedure Improves Endovascular Treatment Outcome in Patients with Acute Ischemic Stroke
摘要
Abstract
Objective The efficacy of endovascular treatment (EVT) for cerebral large vessel occlusion (LVO) was strongly time-dependent. Emergency medical service (EMS) prehospital notification procedure (PNP) may reduce door to reperfusion time (DRT). This study was aimed to examine whether PNP by EMS providers could reduce DRT and improve neurological outcome in LVO patients who received EVT. Methods A retrospective analysis was made upon clinical and imaging data of LVO patients who received EVT and were enrolled consecutively. The effect of EMS with PNP (PNP group), EMS without PNP (Non-PNP group) and non-EMS group on DRT, and the subsequent neurological outcome were compared. Good outcome was defined as modified Rankin Scale (mRS) ≤2 at 3 month. The difference in DRT and clinical outcome were compared among PNP group, Non- PNP group and Non-EMS group. Results Finally, 110 patients were included (average age: 68±12 years, female: 49, 44.5%). Among which, 91 (82.7%) patients were transferred by EMS, of whom 21 (19.1%) patients were PNP. There was no difference in DRT between EMS without PNP group and non-EMS group (180 min vs 194 min,t=0.663,P=0.510),while EMS with PNP group tended to have shorter DRT than non-EMS group(145 min vs 194 min,t=2.260,P=0.055)and EMS with PNP group had shorter DRT than Non-PNP group(145 min vs 180 min,t=-2.065,P=0.043).Multivariate analysis showed that EMS with PNP was independently associated with good outcome after adjusting for hypertension, baseline systolic blood pressure and baseline National Institute of Health Stroke Scale (NIHSS) [odds ratio (OR) 3.653, 95% confidence interval (CI) 1.085-12.301, P=0.037]. When DRT was included in the regression model,DRT was independently associated with good outcome(OR=0.981,95% CI 0.968-0.994, P=0.005). Conclusion PNP can improve neurological outcome by shortening door to reperfusion time in patients with endovascular treatment and improve the clinical outcome.关键词
缺血性卒中/大血管闭塞/院前流程/血管内治疗/急救医疗体系Key words
Acute ischemic stroke/Large vessel occlusion/Prehospital notification procedure/Endovascular treatment/Emergency medical service引用本文复制引用
张美霞,陈智才,张睿婷,史飞娜,楼敏..院前预通知流程改善急性缺血性卒中患者血管内治疗的预后[J].中国卒中杂志,2018,13(2):114-121,8.基金项目
国家重点研发计划重大慢性非传染性疾病防控研究-急性缺血性卒中再灌注治疗关键技术与流程改进研究(2016YFC1301500) （2016YFC1301500）
