Analysis Influencing Factors Of Non Rt-PA Intravenous Thrombolysis Or In-hospital Delays With AIS Patients

ObjectiveTo explore the possible causes of in-hospital delay and non intravenous thrombolysis in patients with acute ischemic stroke at ≤ 3.5 hours before entering the hospital,in order to increase the risk of intravenous thrombolysis in our hospital,reduce the rate of disability and death of stroke,and improve the prognosis of patients with AIS.MethodsThrough on-site visits,questionnaires(Appendix to the questionnaire),the patients’ clinical data and hospital visits were registered,We have collected 222 cases of patients were diagnosed as acute ischemic stroke during the period from October 2015 to January 2018,According to whether the DNT time is greater than 60 min,it is divided into delay group(n=141)and non delay group(n=81);Patients were divided into thrombolytic group(n=63)and non thrombolytic group(n=159)according to whether or not to receive intravenous thrombolytic therapy;Comparison between early and late stages Result,Analysis influencing factors of non rt-PA intravenous thrombolysis or in-hospital delays with AIS patients.1.The total of 222 patients were involved in the study,126 were male,56.8% of the total,96 were women,and 43.2% of the total.The minimum age(age)was 49,the maximum was 91,the median age was 68,the average age was 68.8 years,and the standard deviation was 7.77 years.There were 37 patients with coronary heart disease,accounting for 16.7%,185 non coronary patients and 83.3%;Patients with atrial fibrillation were 27,12.2%,196 non atrial fibrillation,87.7%,There were 58 patients with hypertension,26.1%,164 non hypertensive patients,73.9%,76 diabetic patients,34.2% and 146 non diabetic patients,accounting for 65.8%.2.As shown in Table 3.3,the choice of transportation tools for patients and the median time of min,taxi: 48/222(21.6%),135 min,bus: 22/222(9.9%),150 min,95/222(42.8%),80 min,private car: 28/222(12.6%),90 min,the subway: 8(3.6%),95 min,and the other: 21(9.5%),105 min.3.The minimum value 45 min of DNT time(min),the maximum value 120 min,the median DNT time of 67 min,the standard deviation of 14.86 min,The delay group was compared with the non delay group,there was no significant difference in age and sex(p>0.05),indicating that there was no significant difference in age and sex between the delayed group and the non delayed group,and the difference of diabetes,hypertension and NIHSS score was statistically significant(p<0.05).The incidence of diabetes in the delayed group(45.7%)was higher than that of the non delayed group.(15.5%)the prevalence of hypertension in the delayed group(38.4%)was higher than that in the non delayed group(6%)and the NIHSS score of the delayed group(mean value =11.86)was higher than that of the non delayed group(mean value =7.98).Single factor analysis was carried out by chi square test or t test to investigate whether DNT was more than 60 minutes of influence factors,including hypertension treatment,diabetes treatment,green channel,pre hospital pre notification,conversation greater than 5min,elevator waiting for more than 5min,and other factors were statistically significant(p<0.05),indicating the single factor of the above factors.Analysis of the impact of DNT is significant,and the difference of emergency triage is not statistically significant(p>0.05).On the basis of single factor analysis,further multivariate Logistic regression analysis of meaningful variables was carried out.The results are as follows: whether hyperglycemic treatment,pre hospital pre notification,hypertension treatment,conversation greater than 5min,and elevator waiting for more than 5min have significance in the regression equation,which indicates that the above factors can affect the time of DNT.4.There was no significant difference in age and sex between thrombolytic groups and non thrombolytic group(p>0.05).The difference of diabetes,hypertension and NIHSS score was statistically significant(p<0.05),and the prevalence rate of diabetes in non thrombolytic group(42.1%)was higher than that in thrombolytic group.(14.3%)the prevalence of hypertension in the non thrombolytic group(34%)was higher than that in the thrombolytic group(6.3%)and the NIHSS score of the non thrombolytic group(mean value =11.39)was higher than that in the thrombolytic group(mean value =7.85).Single factor analysis was used to study the influencing factors of thrombolysis,including atrial fibrillation,hypertension,diabetes,poor cognition,non target time management,relative taboo,family rejection,and other factors(p<0.05),indicating that the single factor analysis of the above factors was significant to the effect of thrombolysis.There was no significant difference in factors(p>0.05).The significant variables were found on the basis of single factor analysis,and then the multiple factor Logistic regression analysis was carried out for the meaningful variables.The results were as follows: the factors of hypertension,diabetes and disease cognition were analyzed by multiple factor Logistic regression,and it was significant in the regression equation,which showed that the above factors could affect whether Thrombolysis or not.In terms of cognition of disease: the single awareness rate of stroke warning signs was 188(84.7%)and 42 cases(18.9%).The single awareness rate of rt-PA intravenous thrombolytic therapy in the early AIS and the time window restricted by thrombolytic therapy was 98(44.1%),and the double awareness rate was 66 cases(29.7%).5.The admission of July 31,2016(containing)was divided into early group(83 cases).After July 31,2016,the admission was divided into late group(139 cases),and then the early group and late group were divided into thrombolytic group and non thrombolytic group according to whether thrombolytic thrombolysis,and single factor analysis was used to study the influence factors of thrombolytic,and the latter group was not thrombolytic.The influence factors were different from those in the early group.Conclusions1.the percentage of DNT time <60min in our hospital was 36.5%;2.the incidence of thrombolysis in stroke patients with hypertension or diabetes is relatively low;3.pre-hospital notice,emergency hypoglycemic treatment,emergency lowering blood pressure treatment,hospital transport waiting for elevator more than 5min,and Pre-thrombolytic talk time more than 5min are the influencing factors of DNT time delays;4.hypertension,diabetes,patients and their family members’ poor cognition of stroke diseases are the influencing factors of non thrombolytic therapy.