摘要
目的探讨紧急医疗救护系统(EMS)联合静脉溶栓治疗对急性缺血性脑卒中(AIS)患者预后的影响及院内延迟因素。方法采用回顾性队列研究,纳入2023年1月至2025年1月山东省烟台市海阳市中医医院收治的86例AIS患者为研究对象。根据患者接受的绿色通道启动模式,分为观察组(实施院前急救系统启动,43例)和对照组(实施院内急诊科启动,43例)。比较两组患者到达急诊到开始溶栓时间(DNT)情况、神经功能(NIHSS评分)、日常生活能力(BI评分)、认知功能(MMSE评分)、急救效果、并发症发生情况、院内延迟时间及相关因素。结果观察组患者的DNT显著短于对照组(P<0.001),且DNT≤60min的患者占比更高(93.02%vs.76.74%,P=0.035)。观察组的急救总有效率高于对照组(95.35%vs.79.07%,P=0.024)。治疗后,观察组患者的NIHSS评分低于对照组,BI指数和MMSE评分均高于对照组(P<0.001)。观察组并发症总发生率低于对照组(4.65%vs.20.93%,P=0.044)。在多因素分析中,采用EMS模式(β=-10.524,P<0.001)是缩短DNT的独立保护因素,而完成CT检查至获取报告时间(β=0.856,P<0.001)和获取报告至告知溶栓风险时间(β=1.234,P<0.001)的延长是导致DNT延长的独立危险因素。结论在AIS患者的救治中,应用EMS可显著缩短DNT,改善患者神经功能、日常生活能力及认知功能,并降低并发症风险。多因素分析表明,EMS是提升效率的关键,而CT报告出具和医患沟通环节是院内延迟的主要瓶颈,临床实践中应针对这些环节进行重点优化。
Objective To evaluate the effect of Emergency Medical Services(EMS)activation combined with intravenous thrombolysis on outcomes in patients with acute ischemic stroke(AIS),and to identify factors contributing to in-hospital delays.Methods In this retrospective cohort study,86 AIS patients admitted to Haiyang Hospital of Traditional Chinese Medicine from January 2023 to January 2025 were included.Based on the stroke fast-track activation mode,patients were divided into an EMS-activated group(prehospital EMS activation;n=43)and an ED-activated group(in-hospital emergency department activation;n=43).Outcomes compared between groups included door-to-needle time(DNT),neurological function(National Institutes of Health Stroke Scale,NIHSS),activities of daily living(Barthel Index,BI),cognitive function(Mini-Mental State Examination,MMSE),emergency treatment efficacy,complication rates,and in-hospital delay intervals with associated factors.Results The EMS-activated group had a significantly shorter DNT than the ED-activated group(P<0.001),with a higher proportion achieving DNT≤60 minutes(93.02%vs.76.74%,P=0.035).The overall effective rate of emergency treatment was higher in the EMS-activated group(95.35%vs.79.07%,P=0.024).After treatment,the EMS-activated group showed lower NIHSS scores and higher BI and MMSE scores compared with the ED-activated group(P<0.001).The overall complication rate was lower in the EMS-activated group(4.65%vs.20.93%,P=0.044).In multivariable analysis,EMS activation was an independent protective factor for shorter DNT(β=−10.524,P<0.001),whereas longer CT completion-to-report time(β=0.856,P<0.001)and longer report-to-risk disclosure time for thrombolysis(β=1.234,P<0.001)were independent risk factors for prolonged DNT.Conclusion In AIS care,EMS activation significantly shortens DNT,improves neurological function,activities of daily living,and cognitive outcomes,and reduces the risk of complications.Multivariable analysis indicates that EMS activation itself is key to efficiency,while CT reporting and clinician–patient risk communication are major in-hospital bottlenecks;these steps should be prioritized for optimization in clinical practice.
作者
李江涛
王成建
任路辉
姜娜娜
孙玉琳
LI Jiangtao;WANG Chengjian;REN Luhui;JIANG Nana;SUN Yulin(Department of Critical Care Medicine,Haiyang Hospital of Traditional Chinese Medicine,Haiyang,Yantai,Shandong 265100,China)
出处
《中华灾害救援医学》
2025年第8期943-947,共5页
Chinese Journal of Disaster Medicine
