ISSN 2096-7446　CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 ›› 2023, Vol. 4 ›› Issue (7): 644-652.doi: 10.3761/j.issn.2096-7446.2023.07.016

• 证据综合与应用 • 上一篇    下一篇

院前流程优化对缺血性卒中患者治疗延迟影响的Meta分析

郭芝廷 金静芬 刘苑菲 傅雨佳 王旭阳 郭二菱 张玉萍   

  • 出版日期:2023-07-10 发布日期:2023-07-11

The effect of prehospital process optimization on treatment delay in patients with ischemic stroke：a Meta- analysis

GUO Zhiting，JIN Jingfen，LIU Yuanfei，FU Yujia，WANG Xuyang，GUO Erling，ZHANG Yuping   

  • Online:2023-07-10 Published:2023-07-11

摘要：

目的 了解院前流程优化对缺血性卒中治疗延迟及临床结局的影响。方法 计算机检索PubMed、Embase、The Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据知识服务平台、中国知网、维普数据库关于院前流程优化相关的干预性研究或队列研究，检索时限为建库至2022年11月。由2名接受过循证培训的研究者根据纳入排除标准独立筛查文献、提取资料、质量评价后使采用RevMan 5.3软件进行Meta分析。结果 最终纳入24篇文献，共197 154例患者。结果显示，院前流程优化可提升缺血性卒中患者的再灌注治疗率[OR=1.98，95%CI（1.57,2.49），Z=5.75，P＜0.001]，缩短症状出现到溶栓治疗时间[WMD=-21.64，95%CI（-33.32,-9.97），Z=3.63, P＜0.001]、呼叫救护车到溶栓治疗时间[WMD=-30.29，95%CI（-44.14,-16.45），Z=4.29, P＜0.001]以及院内溶栓时间或血管内治疗时间，改善患者临床结局[OR=1.99，95%CI（1.29,3.05），Z=3.12，P=0.002]，但对症状出现到急诊室入门时间改善无显著影响[WMD=-6.88，95%CI（-16.62,2.86），Z=1.38, P=0.17]。 结论 院前流程优化能够有效提升缺血性卒中患者的再灌注治疗率和预后，但对院前时间延迟的改善较小，提示院前阶段流程还需进一步优化。

关键词: 缺血性卒中, 流程优化, 急救医疗服务, 院前延迟, 专题Meta分析

Abstract: Objective To investigate the effect of prehospital procedure optimization on treatment delay and clinical outcome of ischemic stroke. Methods We searched PubMed，Embase，Cochrane Library，Web of Science， China Biomedical Literature Database，Wanfang data knowledge service platform，China National Knowledge Infrastructure，VIP database to collect intervention studies or cohort studies related to pre-hospital workflow optimization. The search period was from the database establishment to November 2022. Two evidence-based trained researchers independently screened literature，extracted data，and evaluated quality according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software. Results Twenty-four literatures with a total of 197 154 patients were included. The results showed that prehospital procedure optimization could improve the rate of reperfusion therapy in patients with ischemic stroke[OR=1.98，95%CI（1.57，2.49），Z=5.75，P<0.001］ and shorten the time from symptom onset to thrombolytic therapy[WMD=-21.64，95%CI（-33.32，-9.97），Z=3.63，P<0.001］， the time from ambulance call to thrombolytic therapy[WMD=-30.29，95%CI（-44.14，-16.45），Z=4.29，P<0.001］ and the time of intra-hospital thrombolytic therapy or intravascular therapy to improve the clinical outcome of patients [OR=1.99，95%CI（1.29，3.05），Z=3.12，P=0.002］，but had no significant effect on the improvement of entry time from symptom onset to emergency room[WMD=-6.88，95%CI（-16.62，2.86），Z=1.38，P=0.17］. Conclusion Prehospital procedure optimization can effectively improve the reperfusion treatment rate and prognosis of patients with ischemic stroke，but the improvement of prehospital time is small，suggesting that the prehospital process needs to be further optim

Key words: Ischemic Stroke, Procedure Optimization, Emergency Medical Services, Prehospital Delay, Meta-Analysis as Topic