- 期刊
Pre-Hospital and In-Hospital Delays after Onset of Acute Ischemic Stroke-A Hospital-Based Study in Southern Taiwan
急性缺血性腦中風病患延遲入院及院內延遲治療原因分析－南台灣某醫院之研究
摘要
關於急性缺血性腦中風以rt-PA治療之最大障礙乃在於時間限制。而本研究之目的即針對這類病患，記錄其到院及到院後接受各項檢查、評估所需之時間，並探討其造成延遲入院之可能因素。自2004年6月1日起至2005年10月31日止，收錄腦中風發病後四小時內到院者共129位病患。在時間紀錄上，病人於發病後至醫院求診所需時間中位數為71分鐘（平均值士標準差82.7±57.7）。其它入院後完成各項檢查、評估耗時間分別為：神經科照會時間10分鐘(11.3±9.9)，電腦斷層掃描17分鐘(9.6±11.3)，心電圖14分鐘(23.3±55)及抽血檢驗報告39分鐘(44.4±24.5)。由複迴歸分析顯示：年齡小於65歲，未受教育者及於清醒時已具中風症狀者均是造成延遲入院之原因。由以上結果得知：雖然以rt-PA治療急性缺血性腦中風時限為三小時，但若考慮到院後檢查、評估耗費之時間，所能接受最遲入院時限則縮短為二小時。成立腦中風醫療小組及建立標準化治療流程可縮短到病患院後之耗時。對於教育宣導方面，不應僅及於社會大眾（尤其只針對未受教育者），更應擴展至所有醫護人員，才能使急性缺血性腦中風的治療獲得全面提昇。
並列摘要
The biggest hurdle for early hospital presentation is the narrow therapeutic window after stroke. The aims of our study were to investigate the time lags and the factors causing pre-hospital and emergency department (ED) delay during acute ischemic stroke attack. Between June 2004 and October 2005, we prospectively studied 129 acute ischemic stroke patients who presented to the ED of the study hospital within 4 hours after symptom onset. Chi-square testing for trend, univariate and multiple logistic regression analyses was performed to evaluate the factors influencing delays in the ED presentation of acute ischemic stroke patients. The median time from symptom onset to ED arrival was 71 (mean±SD, 82.7±57.7) minutes. The median times from ED arrival to neurologic consultation, computed tomography scan, electrocardiogram, and laboratory data completion were 10 (11.3±9.9) minutes, 17 (9.6±11.3) minutes, 14 (23.3±55) minutes, and 39 (44.4±24.5) minutes, respectively. Univariate and multiple logistic regression models revealed that age ＜ 65 years, illiteracy and awakening with symptoms were the most significant factors related to a delay in ED presentation. This study indicates that 2 hours of pre-hospital delay is the cutoff point for thrombolytic therapy. Organization of a stroke team and standardized stroke pathways may help to shorten in-hospital time consumption. Educational efforts should not only focus on the public, but also on the training of ED physicians and other medical personnel.