Abstract: Objective To investigate the influencing factors and improvement measures of "missing the optimal time window for thrombolysis" in patients with acute ischemic stroke (AIS). Methods A total of 180 patients with AIS admitted in our hospital from March 2019 to March 2020 were selected, among them 36 patients (20.00%) received treatment within 3.5 h after onset (timely treatment group), and 144 patients (80.00%) received treatment over 3.5 h after onset (delayed treatment group). The clinical data of patients were collected by questionnaire survey. The main influencing factors of "missing the optimal time window for thrombolysis" were analyzed, and the improvement measures were determined accordingly. Results Multivariate logistic regression analysis showed that the influencing factors of "missing the optimal time window for thrombolysis" for AIS patients were living together with their families, the first hospital, initial symptoms as not fluent speech, blurred vision, and disturbance of consciousness, the mode of transportation, the cognitive score of stroke related knowledge of patients and their families (all P<0.05). Conclusions The average visit time of AIS patients is longer, the visit rate within 3.5 h is lower, and there is still a serious phenomenon of "missing the optimal time window for thrombolysis". In clinical practice, we should strengthen nursing strategies, improve the ability of patients and their families to recognize the initial symptoms of AIS, to finally shorten the treatment time, so that patients with AIS can be treated with thrombolysis as soon as possible.

Key words: Initial symptoms, Delayed visit, Ischemic stroke, Influencing factors, Cognitive level on stroke

摘要： 目的 分析急性缺血性脑卒中(acute ischemic stroke,AIS)患者错过最佳溶栓时间窗的影响因素,及时改进措施,提高救治效率。方法 选择本院2019年3月至2020年3月收治的AIS患者180例,以3.5 h为时间节点,发病后3.5 h内就诊患者有36例(20.00%),设为就诊及时组,发病后>3.5 h就诊的有144例(80.00%),设为就诊延迟组。问卷调查搜集患者临床资料进行统计数据处理,分析导致患者错过最佳溶栓时间窗的主要影响因素,并据此确定改进对策。结果 多因素logistic回归分析显示,AIS患者就诊错过最佳溶栓时间窗的影响因素有与家属同住、首诊医院、首发症状为言语不利/视物不清/意识障碍、转运方式、患者及家属卒中相关知识认知得分(均P<0.05)。结论 AIS患者平均就诊时间较长,3.5 h内就诊率较低,目前仍存在较为严重的错过最佳溶栓时间窗现象,临床应加强护理对策,提高患者及家属对AIS首发症状识别能力,最终缩短就诊时间,使AIS患者及早溶栓治疗。

关键词: 首发症状, 就诊延迟, 缺血性脑卒中, 影响因素, 卒中认知水平