关键词: 急性缺血性卒中, 院前延误, 影响因素, 卫生服务利用行为模型, 溶栓治疗时间窗, 卒中知识

Abstract: Objective To systematically analyze the current status of pre-hospital delay among patients with acute ischemic stroke and explore its multidimensional influencing factors within the framework of the Andersen model, thereby providing an empirical basis for intervention strategies. Methods A total of 186 patients were selected and dichotomized into a delay group and a non-delay group based on the thrombolytic time window (4.5 hours). Data were collected using a self-designed questionnaire. Multivariate logistic regression analysis was employed to identify influencing factors, supplemented by subgroup analyses and population attributable risk percentage (PAR%) calculations. Results Of the 186 questionnaires distributed, 180 were returned, yielding a valid response rate of 96.77%. The pre-hospital delay time for the 180 patients ranged from 45 to 720 minutes, with a mean of (312.67±215.93) minutes. Within this cohort, 128 patients experienced pre-hospital delay beyond the thrombolytic window, whereas 52 did not. Multivariate logistic regression analysis revealed that rural residence (OR=2.798), knowledge of <3 stroke symptoms (OR=3.326), non-utilization of emergency medical services (EMS, i.e., not calling 120) (OR=3.069), a high National Institutes of Health Stroke Scale (NIHSS) score (OR=2.520), and being unaccompanied by family at stroke onset (OR=3.298) were significant determinants of delay (P<0.05). Subgroup analysis indicated that for urban patients, being unaccompanied at onset (OR=6.666) and a high NIHSS score (OR=4.618) were significantly associated with delay (P<0.05). For rural patients, only knowledge of <3 stroke symptoms (OR=3.226) was significantly correlated with delay (P<0.05). Among patients who utilized EMS, a high NIHSS score (OR=3.492) was a significant predictor of delay (P<0.05). For those who did not utilize EMS, both knowledge of <3 stroke symptoms (OR=4.215) and a high NIHSS score (OR=2.217) were significantly associated with delay (P<0.05). The PAR% analysis demonstrated that insufficient stroke knowledge, non-utilization of EMS, and being unaccompanied at onset contributed 63.21%, 57.14%, and 41.69% to the risk of delay, respectively. Conclusion The rate of pre-hospital delay among patients with acute ischemic stroke is substantial. Key influencing factors include place of residence, level of stroke knowledge, utilization of emergency medical services, severity of neurological deficit, and the presence of family members at the time of stroke onset.

Key words: Acute ischemic stroke, Pre-hospital delay, Influencing factors, Health service utilization behavior model, Thrombolytic therapy time window, Stroke knowledge