院前急救医疗服务对缺血性脑卒中患者静脉溶栓预后的影响

目的: 分析浙江省院前急救医疗服务（EMS）是否与缺血性脑卒中患者静脉溶栓的预后相关。方法: 回顾性分析浙江省70家医院中行静脉溶栓治疗的2123例缺血性脑卒中患者的临床资料，根据是否通过急救车途径到达医院急诊室分为EMS组（808例）和非EMS组（1315例）。3个月改良Rankin量表（mRS）评分2分及以下定义为预后良好。比较EMS组和非EMS组起病至溶栓时间（ONT）、起病至入院时间（ODT）、入院至溶栓时间（DNT）和预后的差异，并采用二元Logistic回归分析研究患者3个月预后的影响因素。结果: 与非EMS组比较，EMS组年龄更大、病情更重、合并心房颤动病史比例更高（均P < 0.05），两组ONT、ODT、DNT差异均无统计学意义（均P>0.05）。二元Logistic回归模型分析结果显示，EMS与患者3个月预后良好无相关性（OR=0.856，95%CI：0.664~1.103，P>0.05）。结论: 目前EMS途径尚不能缩短缺血性脑卒中静脉溶栓患者的ONT等，也未能改变其3个月预后。

Effects of emergency medical service on prognosis of ischemic stroke patients treated with intravenous thrombolysis

Objective: To investigate the effect of emergency medical service (EMS) on the prognosis of ischemic stroke patients treated with intravenous thrombolysis. Methods: Clinical data of 2123 ischemic stroke patients treated with intravenous thrombolysis in 70 hospitals in Zhejiang province were retrospectively analyzed. There were 808 patients sent to the hospital by ambulance (EMS group) and 1315 patients by other transportations (non-EMS group). Good outcome was defined as modified Rankin Scale (mRS) ≤ 2 at 3-month. The onset to needle time (ONT), onset to door time (ODT), door to needle time (DNT) and outcome were compared between EMS group and non-EMS group. Binary logistic regression was used to explore the influencing factors for the outcome at 3-month. Results: Compared with the non-EMS group, patients in the EMS group were older, with higher baseline National Institute of Health Sroke Scale (NIHSS) score, and had a higher proportion of atrial fibrillation (all P < 0.05), but there were no significant differences in ONT, ODT and DNT between two groups (all P>0.05). Binary logistic regression showed that EMS was not independently associated with good outcome (OR=0.856, 95%CI:0.664-1.103, P>0.05). Conclusion: EMS had not improve the outcome of patients receiving intravenous thrombolysis in Zhejiang province.