老年急性脑梗死患者静脉溶栓治疗决策延迟现状及影响因素
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(琼海市中医院神经内科,海南 琼海 571400)

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R743;R592

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海南省卫生健康行业科研项目(20A200108)


Delayed decision making of intravenous thrombolysis in elderly patients with acute cerebral infarction and related influencing factors
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(Department of Neurology, Qionghai Hospital of Traditional Chinese Medicine, Qionghai 571400, Hainan Province, China)

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    摘要:

    目的 探讨老年急性脑梗死患者静脉溶栓治疗决策延迟现状及相关影响因素。方法 回顾性分析2021年4月至2023年4月琼海市中医院收治的291例老年急性脑梗死患者的临床资料,患者均在琼海市中医院行静脉溶栓治疗。分析老年急性脑梗死患者静脉溶栓治疗决策延迟的原因,并比较不同临床特征患者静脉溶栓治疗决策延迟时间。通过多因素logistic回归分析老年急性脑梗死患者静脉溶栓治疗决策延迟的危险因素。采用SPSS 22.0统计软件进行数据分析,两组间比较采用独立样本t检验;多组间比较采用单因素方差分析,两两对比采用LSD-t检验。结果 291例老年急性脑梗死患者中决策延迟原因以缺乏疾病相关知识为主,占比达40.55%(118/291),患者及家属静脉溶栓治疗决策时间为(34.28±10.40)min。单因素分析结果显示性别、发病至入院时间、家庭月均收入、是否意识到急性脑梗死的发生、是否初次发病、是否意识到症状的严重性及静脉溶栓治疗方面比较,差异均无统计学意义;但年龄、决策者、既往是否接受过疾病相关知识、是否关注疾病发生的危险因素并积极预防老年急性脑梗死方面比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄≥70岁(OR=3.420,95%CI 1.273~9.188;P=0.015)、决策者为患者及家属(OR=1.244,95%CI 1.037~1.492;P=0.019)、既往未接受过疾病相关知识的宣教(OR=4.579,95%CI 1.507~13.913;P=0.007)、未关注疾病发生的危险因素并积极预防(OR=2.333,95%CI 1.148~4.741;P=0.019)为老年急性脑梗死患者静脉溶栓治疗决策延迟的危险因素。结论 老年急性脑梗死患者静脉溶栓治疗决策延迟受到诸多因素的影响,临床应结合相关影响因素及时识别并采取相应干预措施。

    Abstract:

    Objective To investigate the status quo of delayed intravenous thrombolysis (IVT) decision making and related influencing factors in elderly patients with acute cerebral infarction (ACI). Methods Clinical data of 291 elderly ACI patients receiving IVT in our hospital from April 2021 to April 2023 were collected and retrospectively analyzed. The reasons of delayed decision for IVT were analyzed, and the delayed decision time was compared in the patients with different clinical characteristics. Multivariate logistic regression analysis was used to analyze the risk factors of delayed IVT decision in elderly ACI patients. SPSS statistics 22.0 was employed for statistical analysis. Independent sample t test was utilized for comparison between two groups, one-way analysis of variance for comparison among multiple groups, and LSD-t test for pairwise comparisons. Results In the 291 elderly ACI patients, the main reason for delayed decision making was lack of disease-related knowledge, accounting for 40.55% (118/291), and the decision time of IVT was (34.28±10.40) min for these patients and their families. The results of univariate analysis showed that there were no significant differences in gender, time from onset to admission, monthly family income, awareness of ACI occurrence, first onset, severity of symptoms, and intravenous thrombolytic therapy between two groups, but significant differences were observed in age, decision-makers, whether they had received the relevant knowledge of disease, whether they paid attention to the risk factors of disease and active prevention for ACI in the elderly (P<0.05). Multivariate logistic regression analysis indicated that age ≥70 years old (OR=3.420, 95%CI 1.273-9.188; P=0.015), patients and their families as decision makers (OR=1.244, 95%CI 1.037-1.492; P=0.019), not receiving disease-related knowledge in the past (OR=4.579, 95%CI 1.507-13.913; P=0.007), no attention to the risk factors of disease occurrence and active prevention (OR=2.333, 95%CI 1.148-4.741; P=0.019) were risk factors for delayed IVT decision in elderly ACI patients. Conclusion The delayed decision of IVT therapy in elderly ACI patients is affected by many factors. Clinical identification and corresponding intervention should be taken in combination with relevant factors.

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张小阳,吴斌.老年急性脑梗死患者静脉溶栓治疗决策延迟现状及影响因素[J].中华老年多器官疾病杂志,2024,23(5):356~359

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  • 收稿日期:2023-05-29
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  • 在线发布日期: 2024-05-15
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