Analysis Of Influencing Factors Of Pre-hospital Delay In Patients With Acute Ischemic Stroke

Background:Acute ischemic stroke is one of the major diseases leading to the increase of global mortality,which brings heavy economic burden to families,societies and countries.A large number of studies have confirmed that intravenous thrombolysis within 3~4.5 hours after onset is the most effective treatment for acute ischemic stroke.However,the time of thrombolytic window is very short,and most patients can not see a doctor in time for various reasons,thus missing the best treatment time.Studies have shown that delays in treatment are the main reason why most patients with acute ischemic stroke fail to receive timely thrombolytic therapy.The most important part of treatment delay is pre-hospital delay,so how to shorten the pre-hospital delay time to increase the chances of thrombolytic therapy has become the focus of attention.A lot of studies have been done on the pre-hospital influencing factors of acute ischemic stroke in different regions at home and abroad,but the results are not consistent.Therefore,the pre-hospital influencing factors of acute ischemic stroke for residents need to be further studied.Objective:The purpose of this study is to observe the early consultation of patients with acute ischemic stroke,and to analyze the influencing factors of delayed consultation,so as to find possible solutions.Methods:A cross-sectional survey was conducted to collect 210 inpatients with acute ischemic stroke from August 2017 to October 2018 in the thirteenth ward of Department of Neurology,Xianyang Hospital,Yan'an University.The contents of the survey included basic information of residents,pre-hospital delay time of patients and possible factors affecting pre-hospital delay.Taking 3.5 hours as the limit,the subjects were divided into delayed group and timely group.The differences of influencing factors of pre-hospital delay between the two groups were compared by single factor and multi-factor regression analysis.Results:In this study,210 patients,196 completed questionnaires,including 45(22.96%)patients in the timely group,151(77.04%)patients in the delayed group and 16(8.16%)patients in the thrombolytic group.1.There was no significant difference between the two groups in basic information,initial onset or location.The onset time,first-visit hospital,symptoms found by others,knowledge of cerebrovascular disease,mode of transit 120 ambulances,unclear speech,visual changes,changes in consciousness,more than or equal to two symptoms,limb numbness.and headache had statistical significance(P<0.05).2.The proportion of patients with onset time of illness in daytime,first-visit hospital as a second-class hospital,symptoms found by others,cerebrovascular disease as a known symptom,120 ambulances as a transit mode and the first symptoms as unclear speech,visual impairment,change of consciousness and more than two symptoms of illness in the timely group was higher.3.Logistic regression analysis of the controllable factors affecting pre-hospital delay showed that symptoms and stroke symptoms were risk factors for pre-hospital delay.Other means of transport are protective factors affecting patients' pre-hospital delay.Conclusion:1.Time of onset,first-visit hospital,whether symptoms were found by others,whether symptoms were cerebrovascular diseases,120 ambulances were transported,the first symptoms were unclear speech,visual disturbance,change of consciousness,more than or equal to two symptoms,limb weakness and numbness,headache were the influencing factors of pre-hospital delay of acute ischemic stroke.2.The factors that shorten the delayed time before hospitalization are:(1)daytime onset;(2)symptoms found by others;(3)changes in consciousness,speech,vision and symptoms more than or equal to two;(4)awareness of symptoms of cerebrovascular diseases;(5)changes in transshipment of 120 ambulances;(6)first visit to a first-class or second-class hospital.3.The adverse factors of pre-hospital delays of acute ischemic stroke were found by others and cerebrovascular diseases were known to be the symptoms;other transport vehicles were selected as the favorable factors.