Study On The Changes Of Intravenous Thrombolysis Time Flow In Acute Ischemic Stroke Under The COVID-19 Pandemic

Objective: We aimed to study and confirm the impact of COVID-19 on the ultra-early emergency treatment of acute ischemic stroke by analyzing the changes of various time indicators in the intravenous thrombolysis procedure before and after the COVID-19 outbreak.Methods: We take January 23,2020 and April 8,2020 as the nodes of Wuhan city lockdown and unlockdown.A retrospective analysis was conducted on patients with acute ischemic stroke who were admitted to Linquan County People’s Hospital and completed intravenous thrombolysis.The patients were divided into pre-epidemic group(98 patients from November8,2019 to January 22,2020).the initial epidemic group(78 patients from January 23,2020 to April 8,2020)and the non-epidemic group(93 patients from January 23,2019 to April 8,2019).The database was established,and the SPSS20.0 software was used for statistical analysis and processing.Chi-square test or t test was used to analyze the change of visit time.The differences in functional outcomes were evaluated by the modified Rankin Scale(m RS)score at 90 days after discharge,90-day mortality,s ICH(symptomatic intracranial hemorrhage)and other indicators.Results:There were 269 patients in the three groups.78 patients in the initial epidemic group were compared with 98 patients in the pre epidemic group,and compared with 93 patients in the 2019 group.There were no statistically significant differences in age gender,vascular risk factors(smoking history,drinking history,hypertension history,stroke/TIA history,diabetes history,atrial fibrillation history),and the severity of neurological deficit in stroke(baseline NIHSS score)(p>0.05).The pre hospital time(OTD)from onset to admission in the initial epidemic group was significantly longer than pre epidemic group [(184 ± 67.7)min vs(130.8± 50.3)min,p<0.05],and in 2019 [(184 ± 67.7)min vs(125.8 ± 48.3)min,p<0.05].The time from onset to the beginning of intravenous thrombolytic therapy(ONT)in the early epidemic group was significantly longer than that in the pre epidemic group [(230 ± 81.7)min vs(179.8± 65.3)min,p<0.05],and compared with that in the 2019 group [(230 ± 81.7)min vs(175.5 ±60.3)min,p<0.05].The time from admission to the beginning of intravenous thrombolysis(DNT)and the time from admission to imaging examination(DTI)were significantly prolonged at the initial stage of the epidemic(p<0.05).There was no significant difference in functional prognosis between the early epidemic group and the other two groups(p>0.05).Conclusion:The results of the control experiment showed that the pre-hospital time,the time from onset to onset of intravenous thrombolysis,the time from admission to onset of intravenous thrombolysis,and the time from admission to imaging examination were all prolonged in the early stage of the epidemic.It is necessary to improve the screening process for COVID-19 on admission.