急性脑梗死静脉溶栓决策延迟影响因素

doi:10.20223/j.cnki.1000-8535.2025.05.008

摘要/Abstract

摘要： 目的探讨影响急性脑梗死患者接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗决策延迟的因素,并提出减少溶栓决策时间的建议。方法采用回顾性分析方法 ,对泉州市第一医院2023年通过急诊收治的120例急性脑梗死患者及其家属的资料进行分析。根据溶栓决策时间,以5 min为界限,将患者分为非延迟组（62例）和延迟组（58例）,并对两组资料进行比较分析。采用SPSS 23.0统计软件分析数据,运用t检验（针对连续变量）和χ²检验（针对分类变量）比较组间的差异。此外,通过Logistic回归分析,确定影响急性脑梗死患者静脉溶栓治疗决策的危险因素。结果对比两组患者数据后发现,籍贯地区、冠心病史、外院转入、发病到入院时间以及决策家属数量比较差异具有统计学意义（P<0.05）。多因素Logistic回归分析进一步揭示,非泉州籍贯地区[OR（95%CI）：9.29（2.21~38.97）,P=0.002]、决策家属人数≥2人[OR（95%CI）：18.73（5.96~58.80）,P<0.001]、从外院转入[OR（95%CI）：10.26（2.09~50.42）,P=0.004]以及发病到入院时间3.0~4.5 h[OR（95%CI）：4.09（1.45~11.48）,P=0.008]是导致治疗决策延迟的独立危险因素。结论患者非泉州籍贯地区、外院转入、溶栓决策家属人员≥2个、发病到入院时间3~4.5 h是溶栓决策延误的影响因素,提出优化卒中急诊抢救流程以及通过卒中宣教以缩短溶栓决策时间的建议。

关键词: 急性脑梗死, 静脉溶栓, 溶栓决策, 决策延迟

Abstract: Objective To investigate the factors influencing delays in decision-making for intravenous thrombolysis with recombinant tissue plasminogen activator（rt-PA）in patients with acute cerebral infarction and to propose recommendations for reducing thrombolysis decision-making time．Methods A retrospective analysis was conducted on data from 120 patients with acute cerebral infarction admitted to the emergency department at Quanzhou First Hospital in 2023,including information from their families．Patients were divided into non-delay group （62 cases） and delay group （58 cases） based on a 5-minute threshold for thrombolysis decision-making time．Comparative analysis between the two groups was performed using SPSS 23.0 statistical software,with t-tests for continuous variables and χ² tests for categorical variables．Logistic regression analysis was employed to identify risk factors affecting decision-making for intravenous thrombolysis in these patients．Results Statistical analysis revealed significant differences between the two groups in terms of native region,history of coronary heart disease,transfer from other hospitals,time from onset to hospital admission,and number of family members involved in decision-making（P<0.05）．Multivariate Logistic regression identified independent risk factors for delayed treatment decisions：non-Quanzhou native region （OR[95%CI]：9.29[2.21-38.97],P=0.002）,having two or more decision-making family members （OR[95%CI]：18.73[5.96-58.80],P<0.001）,transfer from other hospitals （OR[95%CI]：10.26[2.09-50.42],P=0.004）,and a time from onset to hospital admission of 3-4.5 hours （OR[95%CI]：4.09[1.45-11.48],P=0.008）．Conclusions Factors such as non-Quanzhou native region,transfer from other hospitals,having two or more family members involved in decision-making,and a time from onset to hospital admission of 3-4.5 hours are associated with delays in thrombolysis decision-making．Optimizing the emergency rescue process for stroke and shortening the thrombolytic decision-making time through stroke education are suggested．

Key words: acute cerebral infarction, intravenous thrombolysis, thrombolysis decision-making, decision-making delay

苏钦坡, 王杰华, 陈渊洁. 急性脑梗死静脉溶栓决策延迟影响因素[J]. 广州医药, 2025, 56(5): 630-637.

SU Qinpo, WANG Jiehua, CHEN Yuanjie. Factors influencing decision delays in intravenous thrombolysis for acute ischemic stroke[J]. Guangzhou Medical Journal, 2025, 56(5): 630-637.

参考文献

[1] FEIGIN V L,BRAININ M,NORRVING B,et al.World Stroke Organization (WSO):Global Stroke Fact Sheet 2022[J].Int J Stroke,2022,17(1):18-29.
[2] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组,中华医学会神经病学分会神经血管介入协作组.中国急性缺血性卒中早期血管内介入诊疗指南2022[J].中华神经科杂志,2022,55(6):565-580.
[3] 胡一凡. 复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中的安全性及疗效分析[J].广州医药,2024,55(3):306-310.
[4] SAINI V,GUADA L,YAVAGAL D R.Global epidemiology of stroke and access to acute ischemic stroke interventions[J].Neurology,2021,97(20 Suppl 2):S6-S16.
[5] KURIAKOSE D,XIAO Z.Pathophysiology and treatment of stroke:Present status and future perspectives[J].Int J Mol Sci,2020,21(20):7609.
[6] 《中国脑卒中防治报告2021》编写组,王陇德.《中国脑卒中防治报告2021》概要[J].中国脑血管病杂志,2023,20(11):783-792,封3.
[7] MENDELSON S J,COURTNEY D M,GORDON E J, et al.National practice patterns of obtaining informed consent for stroke thrombolysis[J].Stroke,2018,49(3):765-767.
[8] ZONJEE V J,SLENDERS J P L,DE BEER F,et al.Practice variation in the informed consent procedure for thrombolysis in acute ischemic stroke:A survey among neurologists and neurology residents[J].BMC Med Ethics,2021,22(1):114.
[9] CHAI E,LI C,JIANG L.Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke:A retrospective cohort study[J].Medicine,2019,98(19):e15422.
[10] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682.
[11] 荣可欣. 急性脑梗死患者静脉溶栓治疗决策延迟现状及影响因素分析[D].沈阳:中国医科大学,2023.
[12] 张小阳,吴斌.老年急性脑梗死患者静脉溶栓治疗决策延迟现状及影响因素[J].中华老年多器官疾病杂志,2024,23(5):356-359.
[13] GUO Y,LIU Y,GUO L,et al.Decision-making psychological state and characteristic of proxies of thrombolytic patients:A pilot study[J].Sci Rep,2022,12(1):10345.
[14] 陈鑫,周婷婷,沈加兵,等.流程质控在急性缺血性卒中静脉溶栓治疗中的应用[J].南通大学学报(医学版),2020,40(6):499-501.
[15] 范淑红. 院前针对性急救医疗干预在行静脉溶栓急性脑梗死患者中的应用[J].吉林医学,2022,43(9):2396-2398.
[16] 陈蕾,袁丙坤,彭成,等.区域脑卒中救治平台的构建[J].现代医院,2021,21(11):1755-1757.
[17] 郭园丽,马珂珂,杨彩侠,等.急性缺血性脑卒中患者及代理决策者溶栓决策的质性研究[J].护理学杂志,2021,36(16):43-46.
[18] 冯晓昉. 优化急诊绿色通道在急性脑梗死患者中的应用及效果评价[J].中国实用护理杂志,2019,35(33):2567-2570.
[19] SKOLARUS L E,O’BRIEN A,MEURER W J, et al.Getting the gist across is enough for informed consent for acute stroke thrombolytics[J].Stroke,2019,50(6):1595-1597.
[20] 张学梅,姜丽娟,虞亚蔚.急性缺血性卒中患者及家属参与静脉溶栓决策的质性研究[J].南通大学学报(医学版),2021,41(5):463-466.
[21] 潘习,徐岚,王稚,等.急性脑梗死静脉溶栓治疗患者知情同意实践的研究现状[J].中华现代护理杂志,2020,26(1):122-127.
[22] 潘习,王稚,徐岚,等.不同信息呈现方式对急性脑梗死患者家属溶栓风险决策的影响[J].交通医学,2019,33(3):301-303,306.
[23] 程丹丹,李翠华.多元化健康教育对急性脑梗死静脉溶栓治疗患者知信行水平及遵医行为的影响[J].中国急救复苏与灾害医学杂志,2021,16(2):193-196.
[24] 杨玉梅,封蕾,杨希,等.社区健康教育对急性脑梗死静脉溶栓治疗的影响[J].中风与神经疾病杂志,2019,36(6):531-535.
[25] 刘小川. “中风1-2-0”用于中国居民卒中教育的应用研究[D].芜湖:皖南医学院,2021.