Pre-hospital delay in the use of intravenous rt-PA for acute ischemic stroke in Japan
Pre-hospital delay in the use of intravenous rt-PA for acute ischemic stroke in Japan
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DOI：
10.1016/j.jns.2008.02.018
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发表时间：
2008-07-15
影响因子：
4.4
通讯作者：
Uchino, Makoto
中科院分区：
文献类型：
--
作者：
Inatomi, Yuichiro;Yonehara, Toshiro;Uchino, Makoto
在这项研究中，我们调查了日本院前延迟静脉注射重组组织-纤溶酶原激活剂（rt-PA）治疗急性缺血性卒中和短暂性发作的相关因素。在625例患者中，我们调查了他们到达我院的途径和时间，以及患者临床背景中与延迟到达（通知后2小时）相关的重要和独立因素。共287例患者通过EMS直接到达我院，113例患者自行来到我院，225例患者从其他医院转诊过来。423例患者（68%）出现延迟到达。多因素分析显示，住院通知、病情恶化和转诊与延迟到达呈正相关，晚发病、发病时有目击者、意识丧失和使用EMS与延迟到达呈负相关；病程恶化与延迟报警呈正相关，住院通知、发病时有证人、意识丧失和入院时NIHSS高与延迟报警呈负相关；高胆固醇血症与在养老院的发病呈正相关，而在其他医院住院、意识丧失和入院时高NIHSS与未使用EMS呈负相关。医务人员和公众对卒中急救知识的缺乏可能是导致一些卒中患者失去rt-PA治疗机会的原因。(c) 2008 Elsevier B.V.版权所有
In this study we investigated the factors associated with pre-hospital delay to treat acute ischemic stroke and transient attack with intravenous recombinant tissue-plasminogen activator (rt-PA) in Japan. In 625 patients, we investigated the pathways and times of their arrival to our hospital, and the significant and independent factors in the patients' clinical backgrounds associated with delayed arrival (> 2 h after notice). In total, 287 patients arrived at our hospital directly via EMS, 113 came by themselves, and 225 transferred from other institutes. Delayed arrivals occurred in 423 patients (68%). Multivariate analyses showed that staying in another hospital at notice, a worsened course, and referral from other institutes were positively related, and evening onset, having a witness at onset, loss of consciousness, and using EMS were negatively related to delayed arrival; a worsened course was positively related, and staying in other hospital at notice, having a witness at onset, loss of consciousness, and a high NIHSS on admission were negatively related to delayed alert; hypercholesterolemia and onset in a nursing home were positively related, and staying in other hospital at notice, loss of consciousness, and a high NIHSS on admission were negatively related to not using EMS. A lack of knowledge concerning stroke emergency by medical staff as well as the general public may be responsible for some stroke patients losing the chance for rt-PA treatment. (c) 2008 Elsevier B.V. All rights reserved.