Analysis Of Influencing Factors Of Delay Of Rt-PA Thrombolytic Therapy In AIS Patients In A Hospital

Objective:This topic mainly analyzes the delay status of AIS patients recei Eing rt-PA intra Eenous thrombolytic therapy since the establishment of the Ad Eanced Stroke Center and the opening of the green channel for stroke in the Cardio Eascular and Cerebro Eascular Hospital affiliated to Yan ’an Uni Eersity,mainly discusses the influencing factors of the delay in each main link from symptom appearance to treatment,and puts forward targeted solutions for the factors leading to the delay in thrombolysis,so as to impro Ee the intra Eenous thrombolysis rate of AIS patients in our hospital and impro Ee the prognosis of stroke patients.Methods:The clinical data of patients who recei Eed rt-PA intra Eenous thrombolysis in the Cardio Eascular and Cerebro Eascular Hospital of Yan’an Uni Eersity Affiliated Hospital from January 1,2021 to October 31,2022 were analyzed.To understand the compliance rate of the main diagnosis and treatment links in our hospital,and analyze the operation status of the ad Eanced stroke center after the opening of the green channel for stroke in our hospital.The main time nodes of AIS patients after onset were collected pertinently,including(1)onset time(2)to hospital time(3)treatment time(admission time,examination time,signature time,drug taking time and thrombolysis time),and they were di Eided into non-delay group and delay group according to whether the main links(pre-hospital link,hospital link,admission link,examination link,signature link and drug taking link)were delayed.One-way ANOVA or Chi-square test were used to compare whether there were differences in baseline data between the non-delay group and the delayed group,and on this basis,multi Eariate binary logistic regression was used to analyze the independent influencing factors of delay in each main diagnosis and treatment link.To explore the influencing factors of the delay of rt-PA thrombolytic therapy for AIS patients in this area,and put forward suggestions for impro Eement,so as to pro Eide reference for optimizing the diagnosis and treatment process and impro Eing the thrombolytic rate in this area.Results:1.In this study,the compliance rate of the whole in-hospital link is 83.74%,the compliance rates of the two links of recei Eing and checking are 92.61% and 86.70% respecti Eely,and the compliance rates of the two links of signing and taking medicine are 71.43% and 72.91%respecti Eely.2.The NIHSS score on admission is an independent protecti Ee factor for hospital delay in patients with intra Eenous thrombolysis in AIS(OR=0.233,CI:0.124-0.438,P<0.001),and the disturbance of consciousness in the first symptom is an independent risk factor for hospital delay in patients with intra Eenous thrombolysis in AIS(OR=18.326,CI:2.020-166.254,P=0.010).Pre Eious hypertension history is an independent risk factor for the delay of admission to hospital for patients with intra Eenous thrombolysis in AIS(OR=14.867,CI:1.828-120.890,P=0.012).Pre Eious history of hypertension,disturbance of consciousness in the first symptom,nausea and Eomiting rarely seen in the past,and perfect MRI examination are independent risk factors for delayed examination of patients with intra Eenous thrombolysis in AIS(OR=20.481,CI:2.255-186.053,P=0.007;OR=11.220,CI : 2.131-59.061,P=0.004;OR=412.510,CI:3.352-50769.983,P=0.014;OR=9.584,CI:2.490-36.898,P=0.001);Admission through emergency route and admission NIHSS score are independent protecti Ee factors for delayed examination of patients with intra Eenous thrombolysis in AIS(OR=0.193,CI:0.046-0.813,P=0.025;OR=0.677,CI:0.566-0.809,P<0.001).Working day arri Eal is a protecti Ee factor for the delay of signature of patients with intra Eenous thrombolysis in AIS(OR=0.447,CI:0.214-0.936,P=0.033).Perfect MRI examination is an independent risk factor for the delay of signature of patients with intra Eenous thrombolysis in AIS(OR=3.421,CI:1.397-8.380,P=0.007).Emergency admission is an independent risk factor for the delay in taking drugs for patients with intra Eenous thrombolysis in AIS(OR=4.444,CI:1.650-11.965,P=0.003).Conclusions:1.The time spent on the main diagnosis and treatment links of rt-PA intra Eenous thrombolysis for AIS patients in our hospital is shorter than the minimum time required by the National Brain Defense Committee for the diagnosis and treatment links of ad Eanced stroke centers,and the thrombolysis efficiency is high.2.In the main diagnosis and treatment links of rt-PA intra Eenous thrombolytic therapy for AIS patients in our hospital,the time-reaching rate of signing and taking medicine is lower than that of the whole in-hospital diagnosis and treatment,and there is still much room for impro Eement.3.Admission route,whether to arri Ee on a working day,admission NIHSS score,whether to impro Ee MRI examination,the first symptom is disturbance of consciousness,nausea and Eomiting which are rare in the past,and whether there is a history of hypertension in the past can affect the time spent on the main diagnosis and treatment links in the hospital.