Objective: To analyze the treatment situation at each time node in the standard in-hospital-stroke(IHS) in the general hospital compared with that in the emergency(community)-onset stroke (COS) group. Methods: A single-center retrospective case-control study was performed.The clinical cases of acute COS group and IHS group who were treated by the same stroke green channel team at Peking Union Medical College Hospital from Jan.2021 to Apr.2024 were included. The treatment process of acute stage of stroke was divided into four time nodes (onset, recognition, admission, and treatment), and the time of each time node was compared and analyzed. Results: A total of 219 ischemic stroke cases were included, comprising 83 and 136 cases in IHS and COS groups, respectively. There were 134 male patients (61.2%) with a mean onset age of (66.3±15.1) years. IHS occurred across various departments, mainly in surgical departments(55/83, 66.2%). Of the perioperative IHS events, 93.7% (45/48) occurred after the surgery. Compared with the COS group, the IHS group showed a higher rate of post-waking stroke[11/32(34.4%) vs 18/136(13.2%), P=0.004], a lower rate of intravenous thrombolysis[9/32 (29.0%) vs 128/136 (94.8%), P0.001], and a higher rate of mechanical thrombectomy [11/32(34.4%) vs 4/136 (2.9%), P0.001].The overall median onset-CT time in the IHS group was shorter than that in the COS group[M (Q1, Q3)] [100 (59, 189)min vs 135(75, 210)min, P=0.030]. In different stages, median time from stroke onset to recognition[25(1, 140) vs 1(1, 30)min,P=0.005] and the on-site/reception CT [30 (19, 40) min vs 16 (11, 26) min, P=0.001] in the IHS group were longer than those in the COS group, while the median time from recognition to admission[30 (10, 48) min vs 76 (53, 137)min, P0.001]was shorter than that in the COS group. Conclusions: By using the standard ischemic stroke care system, the overall treatment time for IHS group is shorter than that of COS groups. However, compared with COS patients, the onset-recognition and admission to examination/treatment time was significantly prolonged for IHS patients, reflecting the need for further optimization of the standardized in-hospital stroke treatment process.
目的： 通过与社区缺血性卒中比较，分析综合医院院内缺血性卒中标准化救治流程中各时间节点救治情况。 方法： 本研究为单中心回顾性病例对照研究。连续纳入2021年1月至2024年4月于北京协和医院就诊、由同一卒中绿色通道团队接诊的急性缺血性社区卒中（COS）组和院内卒中（IHS）组临床病例。将卒中急性期救治流程划分为起病、识别、就（接）诊和治疗四个时间节点，对比分析组间各时间节段用时情况。 结果： 同期内共纳入缺血性卒中病例共219例，其中IHS组83例、COS组136例，男性134例（61.2%），起病年龄为（66.3±15.1）岁。IHS发生科室分布广，以手术科室为主（55/83，66.2%），围手术期卒中约93.7%（45/48）病例发生于术后。与COS组相比，IHS组醒后卒中比例更高［11/32（34.4%）比18/136（13.2%），P=0.004］，静脉溶栓比例更低［9/32（29.0%）比128/136（94.8%），P0.001］，机械取栓比例更高［11/32（34.4%）比4/136（2.9%），P0.001］。IHS组整体中位起病-CT用时与COS组稍短［M（Q1，Q3）］［100（59，189）min比135（75，210）min，P=0.030］。不同环节中，IHS组的起病-识别时间［25（1，140）min比1（1，30）min，P=0.005］和就/接诊-CT环节［30（19，40）min比16（11，26）min，P=0.001］较之于COS组更为耗时，而识别-就诊阶段IHS组用时更短［（30（10，48）min比76（53，137）min，P0.001］。 结论： 标准化救治流程运行下IHS组整体救治时间与COS组稍短；但相比COS组，IHS组患者在症状识别、接诊至检查/治疗阶段均显著延迟，应进一步优化标准化的院内卒中救治流程。.