Clinical Study On Treatment Of Acute Ischemic Stroke By Mobile Stroke Unit In Nanyang City

Background:Stroke is currently recognized as the world’s leading cause of death and disability in urban and rural residents.Intravenous thrombolytic therapy with recombinant tissue-Plasminogen Activator(rt-PA)may benefit patients with acute ischemic stroke within 4.5h of onset.However,due to the strict time window limit of rt-PA thrombolysis at present,it also brings difficulties to clinical treatment in some cases.Despite many efforts to speed up and optimize the management of patients with Acute Stroke,only0.8-1.3% of patients with Acute Ischemic Stroke(AIS)receive intravenous thrombolysis within the golden hour of onset.The emergence of Mobile Stroke Unit(MSU)has directly promoted the diagnosis and treatment of stroke to the pre-hospital level,and revolutionarily shortened the treatment time from onset to thrombolysis.So far,several studies have shown that Msus are more effective than conventional approaches.However,since the investment and establishment of MSU is very huge,and the operation conditions of MSU are different in different times and different regions,we need more research on MSU to discuss its application in specific regions.Objective:To explore the treatment of acute ischemic stroke by mobile stroke unit in Nanyang City from three aspects of time,neurological function recovery and economic benefits.Method:Patients with acute ischemic stroke who were admitted to Nanshi Hospital Affiliated to Henan University from May 2020 to July 2022 and treated with thrombolytic therapy with Alteplase(Boehringer Ingelheim)through mobile stroke unit and routine emergency mode were retrospectively collected.The patients were divided into two groups according to different access routes,namely mobile stroke unit group(stroke vehicle group)and conventional emergency mode group(emergency vehicle group).The results were compared in terms of time(each time period from onset to thrombolysis),short-term and long-term neurological function recovery(NIHSS score at discharge,m RS Score at 90 d follow-up),and economic cost of long-term neurological function recovery(the average cost of reducing m RS Score by 1 point per person at 90 d follow-up).Result:A total of 170 patients were included,including 97 patients in the stroke vehicle group and 73 patients in the emergency vehicle group.Baseline variables(general condition(sex,age),previous history(hypertension,diabetes,atrial fibrillation,old cerebral infarction,smoking,alcohol consumption),laboratory-related blood tests(blood glucose,cholesterol,triglycerides,low density lipoprotein,homocysteine,platelet count,INR),first-visit NIHSS score,and first-visit m RS Score for both groups There was no significant difference between the two groups(p > 0.05).(1)Time comparison: The linear regression model from onset to thrombolysis suggested that the time from departure to arrival and the time from first visit to CT were significant factors affecting the time from onset to thrombolysis between the two groups(p < 0.01).(2)Comparison of short-term and long-term neurological function recovery: Compared with the conventional emergency mode group,the mobile stroke unit group achieved good efficacy in discharge NIHSS score and m RS Score at 90 days of follow-up,and there were statistically significant differences(p < 0.01).In the logistic regression model of m RS Score at 90 d follow-up,the results suggested that the time from onset to thrombolysis,diabetes and other factors were significant factors affecting the difference of m RS Score between the two groups at 90 d follow-up(p < 0.01).(3)Comparison of safety events: There was no death in the two groups during hospitalization,and there was no statistical difference in the occurrence of symptomatic intracranial hemorrhage,gastrointestinal hemorrhage,pulmonary infection and other adverse events between the two groups during hospitalization(p > 0.05).(4)Comparison of economic cost of long-term recovery of neurological function: 96 patients were included in the stroke vehicle group and 71 in the emergency vehicle group.The total cost of m RS Score reduced by 1point per person in the mobile stroke unit group at 90 d follow-up was 47.62 yuan,compared with the conventional emergency mode group.Conclusion:Compared with the conventional emergency mode,the mobile stroke unit improves the diagnosis and treatment to the pre-hospital stage mainly through immediate CT,which provides the precious golden window of thrombolysis for patients,greatly shorens the time of vascular recanalization,promotes the recovery of neurological defects,and reduces the disability rate of patients.Although the mobile stroke unit has a higher input of human,material and financial resources,it has a higher cost performance and more significant social benefits.