| Objective: To explore the improvement of regional stroke medical service process before and after "stroke recognition in thousands of Counties and towns in China" in Nantong.Methods: A multi-center,prospective and interventional before-and-after control study was conducted to analyze Acute ischemic stroke from 15 hospitals in Nantong in the three years from 2020 before and 2021 and 2022 after the "stroke recognition in thousands of Counties and towns in China",hospitalization rate of inpatients within 4.5h,6h and 24 h of onset,intravenous thrombolysis rate within 4.5h and 14 d of onset,and mechanical thrombolysis rate within 6h,24 h and 14 d of onset.Results:1.Comparison of the hospitalization rate of AIS patients in 15 hospitals before and after stroke recognition action: Compared with 2020,the hospitalization rate within4.5h(22.4% vs 16.8%,p < 0.001),6h(34.9% vs 27.0%,p < 0.001)and 24h(56.5% vs47.2%,p < 0.001)of onset in 2021 was significantly higher.Compared with 2020,the hospitalization rate within 4.5h(23.4% vs 16.8%,p < 0.001),6h(29.2% vs 27.0%,p <0.001)and 24h(66.5% vs 47.2%,p < 0.001)of onset in 2022 was significantly higher.The hospitalization rate within 4.5h(23.4% vs 22.4%,p < 0.001)and 24h(66.5% vs56.5%,p < 0.001)in 2022 was significantly higher than that in 2021.2.Comparison of intravenous thrombolysis rate of AIS patients in 15 hospitals before and after stroke recognition action: Compared with 2020,the rate of intravenous thrombolysis within 4.5h(53.1% vs 46.0%,p < 0.001)and 14d(11.9% vs 7.7%,p <0.001)of onset in 2021 was significantly increased;Compared with 2020,the rate of intravenous thrombolysis within 4.5h(53.5% vs 46.0%,p < 0.001)and 14 d(12.5% vs7.7%,p < 0.001)of onset in 2022 was significantly higher.The rate of intravenous thrombolysis at 4.5 h(53.5% vs 53.1%,p < 0.001)and within 14 d(12.5% vs 11.9%,p< 0.001)in 2022 was significantly higher than that in 2021.3.Comparison of mechanical thrombectomy rate of AIS patients in 15 hospitals before and after stroke recognition action: Compared with 2020,the rate of mechanical thrombolysis within 6h(6.8% vs 3.5%,p < 0.001),24h(4.7% vs 2.0%,p < 0.001)and14 d(2.6% vs 0.9%,p < 0.001)of onset in 2021 was significantly increased.Compared with 2020,the rate of mechanical thrombolysis within 6h(7.4% vs 3.5%,p < 0.001),24h(4.6% vs 2.0%,p < 0.001)and 14d(3.1% vs 0.9%,p < 0.001)of onset in 2022 was significantly higher.The rate of mechanical thrombolysis within 6h(7.4% vs 6.8%,p <0.001)and 14d(3.1% vs 2.6%,p < 0.001)in 2022 was significantly higher than that in2021.Conclusion: The stroke recognition in thousands of Counties and towns in Nantong has effectively improved the treatment process of regional stroke patients,increased the hospitalization rate of AIS patients,the rate of intravenous thrombolysis and the rate of mechanical thrombolysis,and improved the regional stroke medical service ability.Objective: To investigate the short-term prognosis and influencing factors of AIS patients undergoing intravenous thrombolysis and intravascular therapy,and to provide theoretical basis for clinical search of controllable risk factors and prognosis judgment.Methods: A total of 692 patients with AIS who received reperfusion therapy in 15 hospitals in Nantong in 2022 and could provide complete data were included as subjects.Baseline data were collected to assess short-term outcomes at discharge using three criteria: 1.According to National Institutes of Health Stroke Scale(NIHSS)scores,poor outcomes on arrival and hospital NIHSS scores: Results: Good prognosis,< 4 results: poor prognosis;2.According to the Modified Rankin Scale(m RS)score,m RS ≤ 2 was classified as good prognosis,m RS > 2 was classified as poor prognosis;3.The absence of HT was defined as good prognosis,while the presence of HT was defined as poor prognosis.Inter-group univariate and multi-factor logistic regression analysis were used to obtain the relevant indicators affecting the prognosis,and Receiver operating characteristic curve(ROC)was drawn to determine the indicators with predictive ability for clinical prognosis.Results: 1.When evaluating the short-term prognosis at discharge according to the difference of NIHSS score at admission and discharge,the univariate analysis results showed that: There were statistically significant differences in age,hypertension,diabetes,history of atrial fibrillation and TOAST classification between the groups of NIHSS score ≥4 and the groups of < 4(p < 0.05).The above factors were incorporated into multivariate logistic regression analysis,and the results showed that: Being older(OR = 1.019,95%CI 1.004-1.035),having a history of hypertension(OR = 1.428,95%CI 1.034-1.971)and a history of atrial fibrillation(OR = 1.882,95% CI 1.282-2.762)had a significantly higher risk of an outcome with NIHSS score difference < 4 points.However,in the TOAST classification,small artery occlusion(OR: 0.547,95%CI: 0.370-0.807)and cardiogenic embolism(OR: 0.474,95%CI: 0.304-0.738)The risk of outcome with NIHSS score difference < 4 points was significantly reduced.ROC curve was drawn and Area under Gurvc(AUC)was compared.The results showed that: In terms of the predictive ability of NIHSS score difference < 4 points after reperfusion therapy in AIS patients,combined prediction(AUC=0.620)was better than age(AUC 0.585),hypertension(AUC=0.561),and atrial fibrillation history(AUC= 0.558).2.When the short-term prognosis at discharge was evaluated according to the m RS Score at discharge,univariate analysis showed that there were statistically significant differences in age,hypertension,diabetes and history of atrial fibrillation between discharge m RS≤2 group and discharge m RS > 2 group(p < 0.05).The above factors were included in multivariate logistic regression analysis,and the results showed that: They were older(OR = 1.023,95%CI 1.007--1.039),had a history of hypertension(OR = 1.974,95%CI 1.426--2.733),had a history of diabetes(OR = 1.983,Patients with 95% CI 1.376--2.859)and a history of atrial fibrillation(OR = 1.717,95% CI 1.213--2.432)had a significantly higher risk of discharge m RS > 2-point outcome.ROC curve was drawn and AUC was compared.The results showed that: In terms of the predictive ability of discharge m RS Score in AIS patients after reperfusion treatment,combined prediction(AUC=0.673)was better than hypertension(AUC=0.598),age(AUC=0.592),diabetes(AUC=0.574),and history of atrial fibrillation(AUC= 0.572),and the difference was statistically significant.3.When evaluating the short-term prognosis at discharge according to HT,univariate analysis showed that there were statistically significant differences between those without HT and those with HT in age,hypertension,diabetes,history of atrial fibrillation and 48 h initiation of antiplatelet therapy(p < 0.05).The above factors were incorporated into multivariate logistic regression analysis,and the results showed as follows: Being older(OR = 1.057,95% CI 1.020-1.095),having a history of hypertension(OR = 2.102,95% CI 1.014-4.355),having a history of diabetes(OR = 3.329,Patients with 95% CI 1.690-6.556),a history of atrial fibrillation(OR = 2.372,95% CI 1.189-4.730),and antiplatelet drug initiation within 48 hours(OR =3.581,95% CI 1.795-7.143)had a significantly increased risk of HT outcome.ROC curve was drawn and AUC was compared.The results showed that: In terms of the ability to predict HT in AIS patients after reperfusion therapy,the combined prediction(AUC=0.797)was better than age(AUC=0.677),diabetes(AUC=0.650),the initiation of antiplatelet therapy at 48h(AUC=0.630),hypertension(AUC=0.605),and atrial fibrillation history(AUC=0.604).The difference was statistically significant.Conclusion:Age,hypertension and history of atrial fibrillation were all independent risk factors for poor short-term prognosis in AIS patients after reperfusion.When the shortterm prognosis was assessed by m RS Score and HT at discharge,diabetes was also an independent risk factor for poor short-term prognosis in AIS patients after reperfusion therapy.When the short-term prognosis was assessed by HT,the initiation of antiplatelet drugs within 48 h was also an independent risk factor for poor short-term prognosis in AIS patients after reperfusion therapy.Combined factors predicted poor prognosis better than single factors. |
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