医院内缺血性脑卒中患者静脉溶栓时间及预后分析

目的: 比较医院内卒中与医院外卒中患者静脉溶栓治疗时间的差异以及医院内卒中患者预后的影响因素。方法: 回顾性分析2017年6月至2018年9月在浙江省71家医院接受静脉溶栓治疗的3050例缺血性脑卒中患者的临床资料。比较医院内卒中（101例）与医院外卒中（2949例）患者溶栓治疗各时间点的差异，并采用二元Logistic回归分析法分析医院内卒中患者静脉溶栓治疗3个月预后的影响因素。结果: 医院内卒中患者比医院外卒中患者的入院至影像时间长53.5（32.0，79.8）min vs 20.0（14.0，28.0）min，P < 0.01]、影像至溶栓时间长47.5（27.3，64.0）min vs 36.0（24.0，53.0）min，P < 0.01]、入院至溶栓时间长99.0（70.5，140.5）min vs 55.0（41.0，74.0）min，P < 0.01]。在医院内卒中患者中，高级卒中中心比初级卒中中心入院至影像时间更长59.5（44.5，83.3）min vs 37.5（16.5，63.5）min，P < 0.01]，入院至溶栓时间更长110.0（77.0，145.0）min vs 88.0（53.8，124.3）min，P < 0.05]，但影像至溶栓时间更短36.5（23.8，60.3）min vs 53.5（34.3，64.8）min，P < 0.05]。二元Logistic回归分析结果显示，年龄（OR=0.934，95%CI：0.882~0.989，P < 0.05）和基线美国国立卫生研究院卒中量表（NIHSS）评分（OR=0.912，95%CI：0.855~0.973，P < 0.01）是医院内卒中患者静脉溶栓治疗3个月预后的独立影响因素。结论: 与医院外卒中相比，医院内卒中存在一定延误，未来需要建立更加流畅的医院内卒中溶栓流程。

Analysis of intravenous thrombolysis time and prognosis in patients with in-hospital stroke

Objective: To compare the time delay between in-hospital stroke and out-of-hospital stroke patients, and to explore the influence factors for the prognosis of in-hospital stroke patients treated by intravenous thrombolysis. Methods: Clinical data of 3050 patients with ischemic stroke who received intravenous thrombolysis in 71 hospitals in Zhejiang province from June 2017 to September 2018 were analyzed. Differences of time delay including door to imaging time (DIT), imaging to needle time (INT) and door to needle time (DNT) between in-hospital stroke (n=101) and out-of-hospital stroke (n=2949) were observed. The influencing factors for the outcome at 3 month after intravenous thrombolysis in patients with in-hospital stroke were analyzed using binary logistic regression analysis. Results: Patients with in-hospital stroke had longer DIT53.5 (32.0-79.8) min vs. 20.0 (14.0-28.0) min, P < 0.01], longer IDT47.5(27.3-64.0)min vs. 36.0(24.0-53.0)min, P < 0.01], and longer DNT99.0 (70.5-140.5) min vs. 55.0 (41.0-74.0) min, P < 0.01], compared with patients with out-of-hospital stroke; patients in comprehensive stroke center had longer DIT59.5(44.5-83.3) min vs. 37.5(16.5-63.5) min, P < 0.01], longer DNT110.0(77.0-145.0) min vs. 88.0 (53.8-124.3) min, P < 0.05], but shorter INT36.5(23.8-60.3)min vs. 53.5 (34.3-64.8) min, P < 0.05], compared with patients in primary stroke center. Age (OR=0.934, 95%CI: 0.882-0.989, P < 0.05) and baseline National Institute of Health Stroke Scale score (OR=0.912, 95%CI: 0.855-0.973, P < 0.01) were independent risk factors for prognosis of in-hospital stroke patients. Conclusion: In-hospital stroke had longer DIT and DNT than out-of-hospital stroke, which suggests that a more smooth thrombolysis process of in-hospital stroke should be established.