| BackgroundStroke,including ischemic stroke and hemorrhagic stroke,is a group of acute cerebrovascular diseases mainly manifested by symptoms and signs of cerebral ischemia or hemorrhagic injury.Stroke,as a common neurological disease,is characterized by high morbidity,high mortality and high disability rate,which brings heavy economic burden to families and society.From 2010 to 2019,the incidence and prevalence of ischemic stroke in China showed an increasing trend,while that of hemorrhagic stroke showed a decreasing trend.According to the trend of aging in China and the data of the seventh population census,the number of people suffering from the stroke in China ranks the first in the world and stroke has become the first cause of death in China.The time window for treatment of acute ischemic stroke(acute cerebral infarction)is narrow.The key to treatment is to open occluded blood vessels as soon as possible,restore the blood supply in the infarction area,and save the ischemic penumbra.After the occurrence of acute hemorrhagic stroke,sudden cerebral vascular rupture can quickly form a hematoma and put pressure on adjacent brain tissue and produce pressure on the adjacent brain tissue,resulting in edema and even midline displacement of the brain tissue around the hematoma,and eventually produce serious neurological defects.Due to the narrow time window for the treatment of acute ischemic stroke and the rapid changes in the condition of acute hemorrhagic stroke,timely assessment of the condition and rapid diagnosis are of great importance.The hospital should establish a fast channel for the diagnosis and treatment of stroke,so as to improve the treatment rate of acute stroke.Many guidelines for the prevention and treatment of cerebrovascular diseases all recommend intravenous thrombolytic therapy for acute ischemic stroke within 4.5 hours of onset,which is one of the most effective drug treatment measures to improve the outcome of acute ischemic stroke.Intravenous thrombolysis can reduce the morbidity and mortality of patients.Efficacy and safety of intravenous thrombolysis show significant time dependence.Green channel for acute stroke can reduce the delay of treatment time(including pre-hospital delay and in-hospital delay),which is an effective way to increase the clinical benefit of the population.Shortening the pre-hospital delay and in-hospital delay is the main direction to optimize the green channel for stroke.ObjectivesThe purpose of this study was to investigate the operation of the stroke center in the Second Affiliated Hospital of Guangzhou Medical University.Our study aimed to count the compliance of the time nodes of the green channel,to analyze the time nodes that did not meet the standards and the reasons why intravenous thrombolysis exceeded the time window.Prognostic factors of intravenous thrombolysis were also analyzed in this study.MethodsThe clinical data of 2577 patients who entered the green channel for stroke in the emergency department of the Second Affiliated Hospital of Guangzhou Medical University from October 2018 to November 2021 were retrospectively analyzed.The extracted patients’ clinical data included:age,gender,time of consultation,mode of arrival,first major clinical symptoms,cerebrovascular disease classification,NIHSS score at onset,CT,CTA or cerebrovascular perfusion reconstruction results;specific time points of the green channel:entry to stroke physician consultation time(DTS),entry to completion of CT examination time(DTC),entry to intravenous thrombolysis administration The specific time points of the green channel are:time from initiation to stroke physician consultation(DTS),time from initiation to completion of CT examination(DTC),time from initiation to intravenous thrombolysis(DNT),and time from initiation to intervention(DPT).To analyze the distribution characteristics of the population with stroke onset,including the number of stroke patients,stroke type,and the rate of attainment of each time node of the green channel based on the specific situation of each time node;the statistics and reasons for the time node of non-attainment;the statistics and reasons for intravenous thrombolysis exceeding the time window;and the prognostic factors of intravenous thrombolysis treatment.Continuous data in this study were described as mean ± standard deviation if they obeyed normal distribution,and t-test was used for comparison between groups.Non-normally distributed data were described as median(lower quartile-upper quartile),and rank sum test was used for comparison between groups.Count data were described as frequencies(percentages),and the χ2 test was used for comparison between groups.All statistical analyses were implemented using SPSS 19.0 software.Results4.1 A total of 2577 stroke patients with green channel were collected,including 1661 male patients(64.45%)and 916 female patients(35.55%),with a higher incidence in males than females.Among them,cerebral infarction in 2002 cases(77.69%),cerebral hemorrhage in 411 cases(15.95%),other diseases in 164 cases(6.36%).4.2 Age distribution of green channel stroke patients admitted to the emergency department of our hospital included 112 young patients aged 18-44 years(4.35%),528 middle-aged patients aged 45-59 years(20.49%),and 1937 elderly patients over 60 years(75.16%).4.3 The approach of green channel patients with stroke:there were 1581 patients(61.35%)who came to the hospital by themselves,and 996 patients(38.65%)who called 120 patients.4.4 Among the patients receiving green channel stroke in the emergency department of our hospital,the last normal time to emergency entry time was 370.36±348.12 min.The consultation time(DTS)from entry to stroke was 6.08min±58.06min,with a median of 1(0,3).The time from entry to completion of CT examination(DTC)was 21.51± 14.16 min,with a median of 19(15,24).The time from entry to intravenous thrombolytic administration(DNT)was 54.80±26.45min,with a median of 51(43,60.25).The time from entry to intervention(DPT)was 169.07±358.66min,with a median of 115(93,151).4.5 Among the green channel stroke patients admitted to the emergency department of our hospital,1357 patients were admitted within 4.5h of onset,188 patients received follow-up intravenous thrombolytic therapy.4.6 Compared with the elderly group,120 patients in the youth group and middle-aged group were admitted to hospital(37 VS 178 VS 778,P=0.013),speech impairment(23 VS 109 VS 509,P=0.021),dizziness(10 VS 27 VS 6,P=0.002),headache(8 VS 13 VS 21,P<0.01),there were statistical differences(P<0.05).4.7 Compared with cerebral hemorrhage group,age[69(61,79)VS 65.5(55,77.25),P<0.01],onset of working time[1027(49.8%)VS 161(39.2%),P<0.01],120 patients[676(32.8%)VS 264(64.2),P<0.01],limb weakness[1480(71.8%)VS 198(48.2%),P<0.01],consciousness disorder[150(7.3%)VS 144(35%),P<0.01],speech disorder[558(27.1%)VS 60(14.6%),P<0.01],askew of the mouth[82(4%)VS 5(1.2%),P<0.01],headache[12(0.6%)VS 24(6.3%),P<0.01],time from onset to hospital arrival[287.5(113,620)VS 116(59,266.25),P<0.01],NIHSS scores[4(2,10)VS 16(7,34),P<0.01],there were statistical differences(P<0.01).4.8 Comparison of individual variables between the onset-to-arrival time group ≤4.5 hours and the>4.5 hours group:120 arrival[676(49.82%)vs 319(26.15%),P<0.01],physical weakness[818(60.28%)vs 905(74.18%),P<0.01],impaired consciousness[251(18.50%)vs 80(6.56%),P<0.01],epileptic seizures[26(1.92%)vs 4(0.33%),P<0.01],and NIHSS score at onset(11.73±11.94 vs 7.1±8.08,P<0.01),all with statistically significant differences(P<0.01).Multivariable logistic regression analysis,showed that 120 arrival,limb weakness,impaired consciousness,epileptic seizures,and NIHSS score at onset were factors influencing whether patients could be seen at ≤4.5 hours.4.9 Patients who were treated with intravenous thrombolytic therapy were divided into good prognosis group and poor prognosis group.Variables were compared between the two groups:age(years)(68.52±10.45 vs 77.24±15.87,P=0.023),heart disease[35(20.96%)vs 10(47.62%),P=0.007],atrial fibrillation[15(8.98%)vs 6(28.57%),P=0.007],cardiogenic cerebral embolism[7(4.19%)vs 5(23.81%),P=0.001],and NIHSS score at presentation(7.58±7.56 vs 15.67±12.25,P=0.007),all with statistically significant differences(P<0.01).Multivariable logistic regression analysis showed that age and NIHSS score at onset were influential factors in the prognosis of patients with intravenous thrombolysis at hospital discharge.Conclusion5.1 Called 120 for an ambulance to come to the hospital,the first symptoms(disorder of consciousness,epileptic seizure)at the onset of stroke were beneficial to shorten the pre-hospital delay time.5.2 Age and NIHSS score at the time of onset wer’e factors influencing the prognosis of patients treated with intravenous thrombolytic therapy at discharge. |
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