2270例卒中患者延误诊治时间的因素分析

目的 分析延误卒中患者诊治时间的院前、院后因素以及对溶栓治疗的影响。方法 采用问卷调查方法，收集2002年6月30日至2003年4月30日在全国35家医院就诊、资料完整的卒中患者2270例，输入数据库。对卒中发生时间、发病后就诊时间、就诊后查检时间、检查方式、医疗方式及到达医院的方式等影响因素进行单因素分析。结果2270例患者中1039例在3h内到达医院，占45．8％；就诊到头部CT或MRI检查时间在30min内的患者为1084例，占47，8％；CT、MRI检查到读出结果所用时间在30min内有1221例，占53，8％；就诊后60min内得到治疗的患者为1250例，为55．1％；家庭运送为1652例，占72．8％，其中有811例，占49、1％，是在发病后6h以内到达医院；救护车运送为618例，占27．2％，使用急救车的患者在6h内到达医院494例，占79，9％；急诊作MRI检查的患者为1178例，占51．9％；无条件作MRI检查者为1092，占48．1％。发病后就诊时间≤6h患者，下列影响因素差异具有显著意义：即到达医院的方式(P＜0．01)、生活方式(P＜0．05)、医疗状况(P＜0．001)、知晓是否为高危个体(P＜0．001)、发病地点(P＜0，01)、居住地点(P＜0．001)、发病地点到医院的距离(P＜0．001)。结论 就诊前延误因素主要为途中延误，求助于120／999急救运送，可缩短医院前延误的时间。

Study of Pre- and In-hospital delayed factors before the treatment in 2270 Patients with Acute Stroke

Objecetive To study the clinical data for the purpose to find the Pre- and In-hospital delayed factors before thrombolytic treatment of acutely strokes patients. Methods 2 270 patients with complete clinical data were admitted in 35 hospitals in China from Jun 30th 2002 to Apr 30th 2003. All cases were divided into two groups according to whether arriving hospital time within 6 h or not, and the delayed factors were analysised with Chi Square Test. Results 1 039 patients (45 .8%) arrived hospital within 3 h after onset of stroke. 1 652(72.8%) patients were sent to hospital by their family members, among them 811 (49.1%) arrived hospital within 6 h. 618 (27.2%) patients were sent by first aid centre by ambulance, among them 494(79.9%) arriving in the hospital within 6 h. 1 084 patients(47.8%) underwent CT scan within 30 min after admitting, other were delayed. Emergent MRI were also performed for 1 178(51.9%) patients.1 250 patients (55.1%)received the treatment within 1h after their arriving. Thrombolytic treatment were given in 103(5.8%)patients among 1 778 ischemic stroked patients. Following factors showed significant between two groups: delayed transportation (P<0.01),living alone or not(P<0.05), the status of medical care (P<0.001),the awareness of high risk person(P<0.001),the onset time (P<0.01),the living environment (P<0.01), and the distance from onset place to hospital (P<0.001). Conclusion The main factor of time delay before arriving hospital is the time for transportation. And call for emergent aid (120/999) might shorten the pre-hospital delay time.