影響急性腦中風就醫時間的相關因素探討

研究背景 : 多年以來，腦中風一直是國人的主要死亡原因之一，從民國52牟開始，腦中風疾病一直是國人十大死亡原因的第一位，且維持了19年的時間，一直到民國71年開始，才退居第二位。隨著高齡社會來臨，老年人口逐年增加，因腦中風疾病而造成的殘障中老人數為數不少，所要付出的醫療成本也因此而持續增加。因此我們選擇急性腦中風為此次主要的討論重點 。而本研究是針對國人急性腦中風發生後有那些因素影響了他們的就醫時間。 材料與方法 : 我們從2000年8月到2001年2月收集共105位疑急性腦血管疾病的病人；這些病人來源包括急診室、門診。每一位病人入院時都接受系統性的神經學檢查和實驗室檢查；病人都接受腦部電腦斷層掃瞄，最後確定急性腦血管疾病者共85位；這些都在48小時內完成。資料如果不齊全會再去詳問和追蹤或重新安排。這些會在入院72小時內完成。本研究以t檢定、ANOVA、X2 test、Yates’correction X2 test 、Fisher’s exact test和Logistic迴歸來分析就醫時間與變項的關係。 研究結果 : 本研究85位急性腦中風病患之就醫到達時間平均為16.18小時（標準差24.55）。病患之年齡、性別﹑教育程度與就醫時間無顯著差異（P>0.05）。有無過去病史之到達時間差異比較，以無過去病史者顯著低於有過去病史者（T檢定，P<0.05）。高血壓﹑糖尿病及喝酒三項之就醫到達時間有顯著差異。病患之發作時間以白天發作者就醫到達時間有顯著快速於晚上發作者（T檢定，P<0.05）；午夜時間（02:00Am~08:00Am）發作者就醫送達之時間顯著遲於上下班時間發作者。頸部僵硬、意識障礙、昏迷、失語症等均以有顯著的快速到達就醫（T檢定，P<0.05）。以2小時切割點將就醫到達時間分為立即就醫（到達時間<2小時）及延遲就醫（到達時間>2小時）發現無過去病史與病患是否延遲就醫並無顯著相關（Yates'' Correction 2 test，P>0.05）。病患患有過去病史數之多寡亦與是否延遲就醫並無顯著性的相關（2 test，P>0.05）。患是否延遲就醫與其是否因發生於週末時並無顯著相關（Yates'' Correction 2 test，P>0.05）。病患發作於晚上，延遲就醫的百分比例為49.1%顯著高於立即就醫之百分比例25%（Yates'' Correction 2 test，P=0.049<0.05）。2小時內到達者以上班時間發作者比例較高，超過2小時的病患以午夜時間發作者較高。頸部僵硬、意識障礙、昏迷、失語症等四項臨床表徵病患會立即就醫之比例顯著較高。病患到達時間與病情嚴重程度評分之間呈顯著的正相關（r=0.3329，P=0.002<0.05），亦即急性腦中風之病情愈嚴重者其到達醫院的時間愈快速。出血性的腦中風比梗塞性者會較早就醫，能於2小時內到達者，出血性者有18位（佔54.5%），梗塞性者有12位（佔24.5%），兩者的百分比例亦呈現顯著性的差異（Yates'' correction 2 test，P<0.05）。 結論 :本族群的基本特性如年齡、性別和教育程度並不會影響急性腦中風的就醫時間。有過去病史的病患常會影響就醫時間, 卻不見得會使病人提早就醫。晚上和午夜發生時都會延遲就醫時間, 而出血性的腦中風會比梗塞性者提早就醫。本研究發現能提早就醫者大部分都取決於立即送醫的行為，而能使病人或家屬作出此決定，病情嚴重程度應是關鍵點。

Background and Purpose : Cerebrovascular disease is the leading cause of death among the elderly in the Taiwan from 1963-1982. It is still the second most fatal cause in persons age ≧ 65 years old. Stroke is always related to other major chronic disease and disabilities in this elderly group ; therefore investigation of stroke is especially important because Taiwanese population is aging rapidly. The aim of this study were to estimated hospital arrival time in unselected sample of stroke patients , to assess the association with some clinical and demography variables. Methods : During 2000.Aug-2001.Feb, we evaluated 105 suspected acute stroke patients admitted at hospital. We included 85 patients after comfirmation of acute onset of Stroke. Data recorded included demographic information, time and type of stroke , clinical presentation, past history and severity of stroke. The complete data should be filled up within 72 hours. We used t-test, ANOVA, X2 test, Yate correction X2 test, Fisher’s exact test and logistic regression to analizied the data. Results : The mean arrival time is 16.18hr(±24.55) in this study. Age, sex, educational level were not siginificantly related to the arrival time in the analysis(p>0.05). Patients without past history arrived earlier than patient with past history(p<0.05). Hypertension, diabetes mellitus and drinking were parameter which affected the arrival time. Daily onset of the acute stroke will arrived faster than the nocturnal onset. Midnight onset was more delayed than during or after the office hours.but onset during weekend did not affected the arrival time.Patients with neck stiffness, conscious disturbance, coma and aphasia shown relatively shortest arrival time.Early arrival defined as within 2 hours of awareness of symptoms. Those hemorrhagic stroke was arrived earlier than ischemic stroke. The earlier arrival time was dependent on the severity of stroke. Conclusion : Age, sex and educational level were not affected the arrival time. Patients with past history affected the arrival time but may not caused the patients arrived earlier. Nocturnal and midnight onset of stroke were delayed the arrival time ; hemorrhagic stroke arrived earlier than ischemic type. The earlier arrival time was dependent to the severity of stroke.