Factors Influencing Early Neurological Recovery in Patients with Acute Ischemic Stroke

Orapen SUKHAVULLI, Siriorn SINDHU, Wanpen PINYOPASSAKUL, Chukiat VIWATWONGKASEM

Abstract


The purposes of this cross-sectional descriptive correlation design ใช้เพื่อศึกษาความสัมพันธ์ของตัวแปรที่เป็นปัจจัยทำนายความสำเร็จของmyocardial reperfusion ซึ่งตัวแปรตามได้แก่onset to needle time และmyocardial reperfusion ส่วนตัวแปรต้นจำนวน10 ตัวแปรแยกออกเป็นด้านระบบบริการสุขภาพคือSTEMI-health service system จำนวน6 ตัวแปรได้แก่Prehospital management, Compliance to STEMI CPG, Coronary care competency, Coronary treatment competency, Emergency department crowding, Health service location  และด้านผู้ป่วยคือDecision to seek treatment และTreatment seeking behavior ซึ่งมี4 ตัวแปรได้แก่Recognize MI symptoms and  appropriate response, Witness response, Perceive severity of symptoms และTreatment seeking behaviorcross-sectional descriptive study were to describe early neurological recovery in patients with acute ischemic stroke and to identify the statistical predictors of early neurological recovery at 24 h and 3 days after admission. A purposive random sampling was employed to recruit 220 AIS patients from 8 hospitals in the southern region of Thailand from January to May 2016, and the data was analyzed by using multivariate logistic regression analysis. The results revealed that moderate and severe stroke severity decreased neurological recovery at 24 h (OR = .095, p < .001, and OR = .126, p < .01, respectively), compared with mild stroke severity. In addition, onset time to rt-PA within 3 h and 3.0 - 4.5 h increased the neurological recovery at 24 h (OR = 22.22, P < .001, and OR = 17.28, P < .01, respectively), compared with those who did not receive rt-PA treatment. Lastly, age > 80 years decreased neurological recovery at 24 h after admission (OR=.361, P < .05). Neurological recovery at 3 days showed that moderate and severe stroke severity decreased neurological recovery (OR = .10, p < .001, and OR = .09, p < .001, respectively), compared with mild stroke severity. Stroke patients who had onset time to rt-PA within 3 h and within 3.0 - 4.5 h increased neurological recovery at 3 days (OR=16.95, P < .05, and OR = 14.43, P < .01, respectively), compared with those who did not receive rt-PA treatment. The findings of this study show that stroke severity and onset time to rt-PA influence early neurological recovery in AIS patients.

Keywords


Early neurological recovery, acute ischemic stroke, onset time to rt-PA

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References


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