后循环脑梗死急诊溶栓的影响因素分析

目的 研究影响急性后循环脑梗死溶栓率的主要原因。方法 回顾性分析2014年6月-2016年6月就诊于首都医科大学附属北京同仁医院神经内科急诊的急性后循环脑梗死患者，纳入发病至就诊时间≤3.5 h有溶栓适应证的患者，分析患者临床资料、是否溶栓及未溶栓原因。结果 本研究共收集急性后循环脑梗死患者67例，满足入组标准的患者共25例（37.3%），平均年龄（64.6±11.9）岁，其中男性16例（64%），最终有7例（28%）接受静脉重组组织型纤溶酶原激活物（recombinant tissue plasminogen activator，rt-PA）溶栓，18例未接受溶栓。两组患者就诊时的美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS）评分差异有显著性，溶栓组NIHSS评分（中位数6，四分位数间距5～13）明显高于未溶栓组（中位数1，四分位数间距0.75～2）（P =0.007）。溶栓组患者就诊-溶栓时间平均为（71.4±13.8）min，未溶栓组患者完成溶栓评估所有检查所需的平均时间为（90.3±30.8）min，两组时间比较差异有显著性（P =0.046）。溶栓组患者发病-就诊时间平均为（140.7±48.5）mi n，与未溶栓组患者（144.7±56.4）mi n比较，差异无显著性（P =0.87）。未溶栓组患者就诊1周后复测NIHSS评分（中位数1，四分位数间距0～3.25）与就诊时的NIHSS评分比较，虽差异无显著性（P =0.125），但有6例（33.3%）患者病情加重。结论 发病后未能及时就诊仍是影响后循环脑梗死急诊溶栓率的主要因素，NIHSS评分低估后循环脑梗死病情、临床医生对轻型卒中溶栓不够重视是导致后循环轻型脑梗死院内延误、溶栓率较低的主要原因。

Analysis of Influence Factors of Emergency Thrombolysis in the Posterior Circulation Cerebral Infarction

Objective The study aimed to analyze the major reason for thrombolysis rate in acute posterior circulation infarction (PCI). Methods Retrospective analysis was made based on acute PCI patients admitted in emergency department of neurology from June 2014 to June 2016. Patients with onset time less than 3.5 hours were included. The clinical data of thrombolysis and the reasons for not receiving thrombolysis were analyzed. Results A total of 67 acute PCI patients were retrospectively analyzed, and 25 patients with mean age 64.6±11.9 years old met the inclusion criteria were enrolled in the study. Among which, there were 64% males (16/25). Only 7 (28%) patients received recombinant tissue plasminogen activator (rt-PA) thrombolysis and 18 didn't receive thrombolysis. The National Institute of Health Stroke Scale (NIHSS) scores was significantly higher in the thrombolysis group (Median 6, interquartile range: 5-13) than that of non-thrombolysis group (Median 1, interquartile range: 0.75-2) (P=0.007). The door to all thrombolysis evaluation finish time of non-thrombolysis group was significantly longer than thromblysis group(90.3±30.8 minutes vs.71.4±13.8 minutes,P=0.046). The symptom onset to Emergency department arrival interval was not significantly different in both groups(140.7±48.5 minutes vs. 144.7±56.4 minutes,P=0.87).The median NIHSS score of non-thrombolysis group was 1 (interquartile range: 0-3.25) on one week follow up, and no significant difference was found when compared with the first evaluation (P=0.125), despite of aggravation in 6 patients (33.3%). Conclusion Prehospital delay was still an important reason influencing the rate of acute PCI thrombolysis. NIHSS score underestimated the condition of the patients with PCI, and insufficient attention to the opportunity of minor stroke thrombolysis were major reasons for the delay of door to needle time, which lead to the low rate of thrombolysis in acute minor PCI.