The Correlate Of Pre-hospital Delay And Prognostic Of Intravenous Thrombolytic Therapy Of Acute Ischemic Stroke In Chinese Population:A Systematic Review And Meta-analysis

Objective: This study adopts the method of Meta analysis to comprehensively analyze the literature of relevant pre-hospital delay acute ischemic stroke and the factors influencing the prognosis of intravenous thrombolysis treatment,and find out the factors influencing the both,so as to provide a reference basis for carrying out the emergency treatment of acute ischemic cerebral stroke in the future.Methods: Pubmed database,Web of Sciences database,Chinese National Knowledge Infrastructure(CNKI)and Wanfang Data Knowledge Service Platform were searched,and relevant literature about the factors affecting the prehospital delay and thrombolytic therapy of acute ischemic stroke in Chinese population published between the establishment of the database and May 31,2019 was collected.Then Stata 15.0 software was used for meta-analysis of the included literature.Results:A total of 45 related articles were included,with a total number of 12,220 respondents.The meta-analysis results indicated that the use of ambulance(OR: 0.23;95% CI: 0.13-0.40),distance from the hospital(OR: 1.61;95% CI: 1.16-2.23),living alone(OR: 1.53;95% CI: 1.26,1.86),understanding the manifestations of stroke(OR:0.34;95% CI: 0.19,0.61),the first diagnosis in their own hospital(OR: 15.75;95%CI: 6.22,39.93),disturbance of consciousness(OR: 0.60;95% CI: 0.49,0.74),history of hypertension(OR: 1.33;95% CI: 1.05,1.69)and symptoms found by others(OR:1.79;95% CI: 1.38,2.32)were the influencing factors of prehospital delay of patients with acute ischemic stroke.Time from disease attack to thrombolytic therapy(OR:1.06;95% CI: 1.01,1.11)and baseline NHISS score(OR: 1.06;95% CI: 1.02,1.10)were the influencing factors of early efficacy of intravenous thrombolysis of patients with acute ischemic stroke.For the patients receiving intravenous thrombolysis,the factors affecting 90-day prognosis included age,time from disease attack to thrombolytic therapy,baseline blood glucose,baseline NIHSS score,symptom improvement 24 hours after thrombolysis,symptomatic intracranial hemorrhage,as well as history of atrial fibrillation.Conclusion: The research results showed that the use of ambulances,awareness of stroke manifestations and consciousness disturbance were protective factors of pre-hospital delay.However,long distance from the hospital,living alone,non-initial diagnosis in our hospital,history of hypertension and self-detected symptoms were risk factors for prehospital delay.Meanwhile,the delay of pre-hospital treatment would lead to the prolonged time from the disease attack of symptoms to the treatment,the aggravation of patients’ condition,and the rise of NIHSS score in hospital,thus affecting the clinical prognosis.Therefore,enhancing the knowledge education for patients with acute ischemic stroke and their families,increasing the utilization rate of ambulance,and establishing a perfect integrated treatment system before and after hospital will change patients’ prognosis and clinical outcome.