Recent Advances in Risk Factors for Delayed Thrombolysis in Ischemic Stroke

doi:10.12114/j.issn.1007-9572.2019.00.132

Abstract

Abstract: Thrombolytic therapy is effective for acute ischemic stroke，if it is delivered within the specified time limit.Delayed access to healthcare is a major cause of inadequate or ineffective thrombolytic therapy.Many factors are associated with delayed treatment for stroke.We discussed them from patient-related，transportation and in-hospital aspects，aiming to provide a reference for related research.

Key words: Stroke, Brain ischemia, Thrombolytic therapy, Treatment delay, Risk factors

摘要： 溶栓是目前治疗急性缺血性卒中的有效措施，但受到时间窗限制，就医延迟是导致患者溶栓治疗不足和低效率的主要原因。卒中就医延迟风险因素众多，本研究从患者延迟、转运延迟及院内延迟3个层面对其进行综述，旨在为相关研究提供参考。

关键词: 卒中, 脑缺血, 血栓溶解疗法, 就医延迟, 危险因素

LIU Qinqin,YANG Li,ZHAO Qiuli, et al. Recent Advances in Risk Factors for Delayed Thrombolysis in Ischemic Stroke　[J]. Chinese General Practice, 2019, 22(16): 2000-2007. DOI: 10.12114/j.issn.1007-9572.2019.00.132.
刘琴琴,杨丽,赵秋利等. 缺血性卒中溶栓就医延迟风险因素研究进展[J]. 中国全科医学, 2019, 22(16): 2000-2007. DOI: 10.12114/j.issn.1007-9572.2019.00.132.

References

［1］WHO．Global status report on noncommunicable diseases 2014［J］．Women，2014，47（26）：2562-2563.
［2］LIU L，WANG D，WONG K S，et al．Stroke and stroke care in China：huge burden，significant workload，and a national priority［J］．Stroke，2011，42（12）：3651-3654．DOI：10.1161/STROKEAHA.111.635755.
［3］WANG W，JIANG B，SUN H，et al．Prevalence，incidence and mortality of stroke in China：results from a nationwide population-based survey of 480 687 adults［J］．Circulation，2017，135（8）：759-771．DOI：10.1161/CIRCULATIONAHA.116.025250.
［4］ZHOU Y，YANG T，GONG Y，et al．Pre-hospital delay after acute ischemic stroke in central urban China：prevalence and risk factors［J］．Molecular Neurobiology，2016，54（4）：3007-3016．DOI：10.1007/s12035-016-9750-4.
［5］霍晓川，高峰．急性缺血性卒中血管内治疗中国指南2018［J］．中国卒中杂志，2018，13（7）：706-729．DOI：10.3969/j.issn.1673-5765.2018.07.014.
HUO X C，GAO F．Chinese guideline for endovascular treatment of acute ischemic stroke 2018［J］．Chin J Stroke，2018，13（7）：706-729．DOI：10.3969/j.issn.1673-5765.2018.07.014.
［6］European Stroke Organisation（ESO）Executive Committee，ESO Writing Committee．Guidelines for management of ischaemic stroke and transient ischaemic attack 2008［J］．Cerebrovascular Diseases，2008，25（5）：457-507．DOI：10.1159/000131083.
［7］WANG Y，LIAO X，ZHAO X，et al．Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China［J］．Stroke，2011，42（6）：1658-1664．DOI：10.1161/STROKEAHA.110.604249.
［8］杨柳．脑卒中院前延迟健康教育的研究进展［J］．中风与神经疾病杂志，2014，31（3）：286-288.
YANG L．Advances in research on health education with patients of pre-hospital delay after stroke［J］．J Apoplexy and Nervous Diseases，2014，31（3）：286-288.
［9］XU A D，WANG Y J，WANG D Z．Consensus statement on the use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke by the Chinese Stroke Therapy Expert Panel［J］．Cns Neuroscience & Therapeutics，2013，19（8）：543-548．DOI：10.1111/cns.12126.
［10］中华医学会神经病学分会．中国急性缺血性脑卒中诊治指南2014［J］．中华神经科杂志，2015，48（4）：246-257．DOI：10.3760/cma.j.issn.1006-7876.2015.04.002.
Chinese Society of Neurology．Guidelines for the diagnosis and treatment of acute ischemic stroke in China 2014［J］．Chin J Neurol，2015，48（4）：246-257．DOI：10.3760/cma.j.issn.1006-7876.2015.04.002.
［11］POWERS W J，RABINSTEIN A A，ACKERSON T，et al．2018 guidelines for the early management of patients with acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association［J］．Stroke，2018，49（3）：e46-110．DOI：10.1161/STR.0000000000000158.
［12］徐安定，丁燕，李牧．中国缺血性卒中早期静脉溶栓的现状、阻碍因素及改进策略［J］．中国卒中杂志，2014，9（6）：522-528．DOI：10.3969/j.issn.1673-5765.2014.06.012.
XU A D，DING Y，LI M．The current state，barriers and improving strategies of intravenous thrombolysis for acute ischemic stroke in China［J］．Chin J Stroke，2014，9（6）：522-528．DOI：10.3969/j.issn.1673-5765.2014.06.012.
［13］EISSA A，KRASS I，LEVI C，et al．Understanding the reasons behind the low utilisation of thrombolysis in stroke［J］．Australasian Medical Journal，2013，6（3）：152-167．DOI：10.4066/AMJ.2013.1607.
［14］EVENSON K R，FORAKER R，MORRIS D L，et al．A comprehensive review of prehospital and in-hospital delay times in acute stroke care［J］．International Journal of Stroke，2009，4（3）：187-199．DOI：10.1111/j.1747-4949.2009.00276.x.
［15］WESTER P，R?DBERG J，LUNDGREN B，et al．Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA：a prospective，multicenter study．Seek- Medical-Attention-in-Time Study Group［J］．Stroke，1999，30（1）：40-48．DOI：10.1161/01.STR.30.1.40.
［16］MORRIS D L，ROSAMOND W，MADDEN K，et al．Prehospital and emergency department delays after acute stroke：the Genentech Stroke Presentation Survey［J］．Stroke，2000，31（11）：2585-2590．DOI：10.1161/01.STR.31.11.2585.
［17］LACY C R，SUH D C，BUENO M，et al．Delay in presentation and evaluation for acute stroke stroke time registry for outcomes knowledge and epidemiology（S.T.R.O.K.E.）［J］．Stroke，2001，32（1）：63-69．DOI：10.1161/01.STR.32.1.63.
［18］ROSAMOND W D，GORTON R A，HINN A R，et al．Rapid response to stroke symptoms：the Delay in Accessing Stroke Healthcare（DASH）Study［J］．Academic Emergency Medicine Official Journal of the Society for Academic Emergency Medicine，2014，5（1）：45-51．DOI：10.1111/j.1553-2712.1998.tb02574.x.
［19］BARR J，MCKINLEY S，O'BRIEN E，et al．Patient recognition of and response to symptoms of TIA or stroke［J］．Neuroepidemiology，2006，26（3）：168-175．DOI：10.1159/000091659.
［20］MANDELZWEIG L，GOLDBOURT U，BOYKO V，et al．Perceptual，social，and behavioral factors associated with delays in seeking medical care in patients with symptoms of acute stroke［J］．Stroke，2006，37（5）：1248-1253．DOI：10.1161/01.STR.0000217200.61167.39.
［21］FELDMANN E，GORDON N，BROOKS J M，et al．Factors associated with early presentation of acute stroke［J］．Stroke，1993，24（12）：1805-1810．DOI：10.1161/01.str.24.12.1805.
［22］PALOMERAS E，FOSSAS P，QUINTANA M，et al．Emergency perception and other variables associated with extra-hospital delay in stroke patients in the Maresme Region（Spain）［J］．European Journal of Neurology，2008，15（4）：329-335．DOI：10.1111/j.1468-1331.2008.02082.x.
［23］CHANG K C，TSENG M C，TAN T Y．Prehospital delay after acute stroke in Kaohsiung，Taiwan［J］．Stroke，2004，35（3）：700-704．DOI：10.1161/01.STR.0000117236.90827.17.
［24］JIN H，ZHU S，WEI J W，et al．Factors associated with prehospital delays in the presentation of acute stroke in urban China［J］．Stroke，2012，43（2）：362-370．DOI：10.1161/STROKEAHA.111.623512.
［25］HOWARD V J，LACKLAND D T，LICHTMAN J H，et al．Care seeking after stroke symptoms［J］．Annals of Neurology，2008，63（4）：466-472．DOI：10.1002/ana.21357.
［26］YANG H，ZHANG J，XIE J，et al．Factors influencing pre-hospital delay among acute ischemic stroke patients in the midlands of China［J］．International Journal of Cardiology，2014，172（2）：533-534．DOI：10.1016/j.ijcard.2014.01.047.
［27］GEFFNER D，LAGO A，TEMBL J，et al．Delayed hospitalization of the patient with acute stroke［J］．Revista De Neurologia，1998，27（160）：947-951.
［28］GOLDSTEIN L B，EDWARDS M G，WOOD D P．Delay between stroke onset and emergency department evaluation［J］．Neuroepidemiology，2001，20（3）：196-200．DOI：10.1159/000054787.
［29］AGYEMAN O，NEDELTCHEV K，ARNOLD M，et al．Time to admission in acute ischemic stroke and transient ischemic attack［J］．Stroke，2006，37（4）：963-966．DOI：10.1161/01.STR.0000206546.76860.6b.
［30］SONG D，TANAKA E，LEE K，et al．Factors associated with early hospital arrival in patients with acute ischemic stroke［J］．Journal of Stroke，2015，17（2）：159-167．DOI：10.5853/jos.2015.17.2.159.
［31］JIANG B，RU X，SUN H，et al．Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China［J］．Scientific Reports，2016，6：29795．DOI：10.1038/srep29795.
［32］MOSLEY I，NICOL M，DONNAN G，et al．Stroke symptoms and the decision to call for an ambulance［J］．Stroke，2007，38（2）：361-366．DOI：10.1161/01.STR.0000254528.17405.cc.
［33］KIM Y S，PARK S S，BAE H J，et al．Public awareness of stroke in Korea：a population-based national survey［J］．Stroke，2012，43（4）：1146-1149．DOI：10.1161/STROKEAHA.111.638460.
［34］LIBMAN R B，KWIATKOWSKI T G，HANSEN M D，et al．Differences between anterior and posterior circulation stroke in TOAST［J］．Cerebrovascular Diseases，2001，11（4）：311-316．DOI：10.1159/000047659.
［35］LAWRENCE E S，COSHALL C，DUNDAS R，et al．Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population［J］．Stroke，2001，32（6）：1279-1284．DOI：10.1161/01.STR.32.6.1279.
［36］ROSSNAGEL K，JUNGEHüLSING G J，NOLTE C H，et al．Out-of-hospital delays in patients with acute stroke［J］．Annals of Emergency Medicine，2004，44（5）：476-483．DOI：10.1016/j.annemergmed.2004.06.019.
［37］FOGELHOLM R，MURROS K，RISSANEN A，et al．Factors delaying hospital admission after acute stroke［J］．Stroke，1996，27（3）：398-400．DOI：10.1161/01.STR.27.3.398.
［38］AZZIMONDI G，BASSEIN L，FIORANI L，et al．Variables associated with hospital arrival time after stroke：effect of delay on the clinical efficiency of early treatment［J］．Stroke，1997，28（3）：537-542．DOI：10.1161/01.STR.28.3.537.
［39］FANG K，CHURILOV L，WEIR L，et al．Thrombolysis for acute ischemic stroke：do patients treated out of hours have a worse outcome?［J］．Journal of Stroke & Cerebrovascular Diseases，2014，23（3）：427-432．DOI：10.1016/j.jstrokecerebrovasdis.2013.03.029.
［40］孙海欣，王文志，江滨，等．中国四城市社区居民卒中知识水平相关因素分析［J］．中国卒中杂志，2012，7（8）：618-625．DOI：10.3969/j.issn.1673-5765.2012.08.005.
SUN H X，WANG W Z，JIANG B，et al．Analysis of related factors on awareness of community residents with stroke-related knowledge in four cities in China［J］．Chin J Stroke，2012，7（8）：618-625．DOI：10.3969/j.issn.1673-5765.2012.08.005.
［41］YANG J，ZHENG M，CHENG S，et al．Knowledge of stroke symptoms and treatment among community residents in western urban China［J］．Journal of Stroke & Cerebrovascular Diseases，2014，23（5）：1216-1224．DOI：10.1016/j.jstrokecerebrovasdis.2013.10.019.
［42］ZENG Y，HE G P，YI G H，et al．Knowledge of stroke warning signs and risk factors among patients with previous stroke or TIA in China［J］．Journal of Clinical Nursing，2012，21（19/20）：2886-2895．DOI：10.1111/j.1365-2702.2012.04118.x.
［43］YIN X，YANG T，GONG Y，et al．Determinants of emergency medical services utilization among acute ischemic stroke patients in Hubei Province in China［J］．Stroke，2016，47（3）：891-894．DOI：10.1161/STROKEAHA.115.011877.
［44］毕齐，张茁，张微微，等．北京等15个城市脑卒中患者院前时间及影响因素研究［J］．中华流行病学杂志，2006，27（11）：996-999．DOI：10.3760/j.issn.0254-6450.2006.11.019.
BI Q，ZHANG Z，ZHANG W W，et al．Study on prehospital time and influencing factors of stroke patients in 15 Chinese cities［J］．Chin J Epidemiol，2006，27（11）：996-999．DOI：10.3760/j.issn.0254-6450.2006.11.019.
［45］FAIZ K W，SUNDSETH A，THOMMESSEN B，et al．Reasons for low thrombolysis rate in a Norwegian ischemic stroke population［J］．Neurol Sci，2014，35（12）：1977-1982．DOI：10.1007/s10072-014-1876-4.
［46］HIGASHIDA R，ALBERTS M J，ALEXANDER D N，et al．Interactions within stroke systems of care：a policy statement from the American Heart Association/American Stroke Association［J］．Stroke，2013，44（10）：2961-2984．DOI：10.1161/STR.0b013e3182a6d2b2.
［47］OOSTEMA J A，KONEN J，CHASSEE T，et al．Clinical predictors of accurate prehospital stroke recognition［J］．Stroke，2015，46（6）：1513-1517．DOI：10.1161/STROKEAHA.115.008650.
［48］EL K R，JUNG R，NANDA A，et al．Overview of key factors in improving access to acute stroke care［J］．Neurology，2012，79（1）：26-34．DOI：10.1212/WNL.0b013e3182695a2a.
［49］FASSBENDER K，BALUCANI C，WALTER S，et al．Streamlining of prehospital stroke management：the golden hour［J］．Lancet Neurology，2013，12（6）：585-596．DOI：10.1016/S1474-4422（13）70100-5.
［50］KWAN J，HAND P，SANDERCOCK P．A systematic review of barriers to delivery of thrombolysis for acute stroke［J］．Age & Ageing，2004，33（2）：94-95．DOI：10.1093/ageing/afh064.
［51］MAZIGHI M，DEREX L，AMARENCO P．Prehospital stroke care：potential，pitfalls，and future［J］．Current Opinion in Neurology，2010，48（2）：351-355．DOI：10.1111/j.1432-1033.1974.tb03776.x.
［52］周艳凤．基于医患双方认知与行为的急性缺血性脑卒中溶栓治疗影响因素研究［D］．武汉：华中科技大学，2017.
［53］王振海，谢柳青，赵春梅，等．急性缺血性脑卒中患者院前及院内延迟因素调查研究［J］．中国全科医学，2012，15（23）：2605-2608．DOI：10.3969/j.issn.1007-9572.2012.08.040.
WANG Z H，XIE L Q，ZHAO C M，et al．Pre-hospital and in-hospital delay after acute ischemic stroke among 231 patients［J］．Chinese General Practice，2012，15（23）：2605-2608．DOI：10.3969/j.issn.1007-9572.2012.08.040.
［54］王兰芝，孙顺成，于玲玲．老年急性脑梗死延迟治疗原因分析与对策［J］．中国误诊学杂志，2007，7（7）：1459-1460．DOI：10.3969/j.issn.1009-6647.2007.07.021.
WANG L Z，SUN S C，YU L L．Causes and countermeasures of delayed treatment for acute cerebral infarction in the elderly［J］．Chin J Misdiagn，2007，7（7）：1459-1460．DOI：10.3969/j.issn.1009-6647.2007.07.021.
［55］王晓磊．烟台市中医医院急性缺血性脑卒中诊治延迟相关因素调查分析［D］．大连：大连医科大学，2013.
［56］谢柳青．急性缺血性脑卒中诊治延迟相关因素调查分析［D］．银川：宁夏医科大学，2012.
［57］苏林霞，杨莘，常红，等．基于价值流程图的缺血性脑卒中患者静脉溶栓院内延迟现状分析［J］．中国护理管理，2015，15（5）：591-594．DOI：10.3969/j.issn.1672-1756.2015.05.022.
SU L X，YANG S，CHANG H，et al．The hospital delay analysis of intravenous thrombolysis process among ischemic stroke patients based on value stream mapping［J］．Chinese Nursing Management，2015，15（5）：591-594．DOI：10.3969/j.issn.1672-1756.2015.05.022.
［58］王亚冰，焦力群，王亚东，等．北京市三甲医院急性脑血管病患者发病至治疗延迟时间分布［J］．中国神经精神疾病杂志，2009，35（1）：22-25．DOI：10.3969/j.issn.1002-0152.2009.01.007.
WANG Y B，JIAO L Q，WANG Y D，et al．The pre-hospital and in-hospital delay time in patients of the acute cerebralvascular disease in Beijing［J］．Chin J Nerv Ment Dis，2009，35（1）：22-25．DOI：10.3969/j.issn.1002-0152.2009.01.007.
［59］刘磊，孔繁军．影响急性缺血性脑卒中溶栓治疗时间窗的因素及干预措施［J］．神经疾病与精神卫生，2007，7（1）：52-54．DOI：10.3969/j.issn.1009-6574.2007.01.021.
LIU L，KONG F J．Factors affecting the time window of thrombolytic therapy for acute ischemic stroke and intervention measures［J］．Nervous Diseases and Mental Health，2007，7（1）：52-54．DOI：10.3969/j.issn.1009-6574.2007.01.021.
［60］MURRAY M，BERWICK D M．Advanced access：reducing waiting and delays in primary care［J］．JAMA，2003，289（8）：1035-1040．DOI：10.1001/jama.289.8.1035.
［61］孙洋洋，葛晓利，戴李华，等．优化院前院内卒中一体化管理模式对急性脑梗死静脉溶栓患者预后的影响［J］．临床误诊误治，2017，30（12）：94-97．DOI：10.3969/j.issn.1002-3429.2017.12.035.
SUN Y Y，GE X L，DAI L H，et al．Effects of improvement of pre-hospital and intra-hospital management on prognosis of patients with acute venous cerebral infarction［J］．Clinical Misdiagnosis ＆ Mistherapy，2017，30（12）：94-97．DOI：10.3969/j.issn.1002-3429.2017.12.035.
［62］章娟．卒中急救的科学计量分析与时间延迟的调查研究［D］．武汉：华中科技大学，2012.
［63］苏暄．缺血性卒中：缩短OTT已成全球性趋势［J］．中国医药科学，2014，4（19）：5-8．DOI：10.3969/j.issn.2095-0616.2014.19.002.
SU X．Ischemic stroke：shortening OTT has become a global trend［J］．China Medicine and Pharmacy，2014，4（19）：5-8．DOI：10.3969/j.issn.2095-0616.2014.19.002.
［64］李凯，龚涛，刘芳，等．静脉溶栓治疗急性缺血性脑卒中22例临床分析［J］．中华全科医师杂志，2012，11（8）：607-609．DOI：10.3760/cma.j.issn.1671-7368.2012.08.020.
LI K，GONG T，LIU F，et al．Intravenous thrombolysis for acute ischemic stroke：analysis of 22 cases［J］．Chinese Journal of General Practitioners，2012，11（8）：607-609．DOI：10.3760/cma.j.issn.1671-7368.2012.08.020.
［65］HUANG Q，MA Q，FENG J，et al．Factors associated with in-hospital delay in intravenous thrombolysis for acute ischemic stroke：lessons from China［J］．PLoS One，2015，10（11）：e0143145．DOI：10.1371/journal.pone.0143145.
［66］SCHROCK J W，LUM M．Drill down analysis of door-to-needle time of acute ischemic stroke patients treated with intravenous tissue plasminogen activator［J］．American Journal of Emergency Medicine，2014，32（11）：1330-1333．DOI：10.1016/j.ajem.2014.08.002.
［67］KENDALL J，DUTTA D，BROWN E．Reducing delay to stroke thrombolysis：lessons learnt from the Stroke 90 Project［J］．Emergency Medicine Journal，2015，32（2）：100-104．DOI：10.1136/emermed-2013-202993.
［68］赵艺皓，吉训明，杨莘．缺血性脑卒中患者溶栓院内延迟现状及其影响因素研究进展［J］．中国护理管理，2016，16（1）：103-107．DOI：10.3969/j.issn.1672-1756.2016.01.028.
ZHAO Y H，JI X M，YANG S．The research progress of the current status and influencing factors of in-hospital delay in thrombolysis process among ischemic stroke patients［J］．Chinese Nursing Management，2016，16（1）：103-107．DOI：10.3969/j.issn.1672-1756.2016.01.028.
［69］黄琳明，赖智勇，崔萍，等．急性缺血性脑卒中溶栓救治院内流程的研究［J］．中国医药指南，2018，16（22）：19-20．DOI：10.15912/j.cnki.gocm.2018.22.012.
HUANG L M，LAI Z Y，CUI P，et al．The study of in-hospital process of thrombolytic therapy for acute ischaemic stroke［J］．Guide of China Medicine，2018，16（22）：19-20．DOI：10.15912/j.cnki.gocm.2018.22.012.
［70］高凤霞，张宝祥，吕东，等．脑卒中患者的诊治延迟因素分析［J］．中国现代医生，2009，47（31）：11-13．DOI：10.3969/j.issn.1673-9701.2009.31.005.
GAO F X，ZHANG B X，LYU D，et al．Delayed factors in diagnosis and treatment of patients with stroke［J］．China Modern Doctor，2009，47（31）：11-13．DOI：10.3969/j.issn.1673-9701.2009.31.005.
［71］MIKULíK R，KADLECOVá P，CZLONKOWSKA A，et al．Factors influencing in-hospital delay in treatment with intravenous thrombolysis［J］．Stroke，2012，43（6）：1578-1583．DOI：10.1161/STROKEAHA.111.644120.
［72］FERRARI J，KNOFLACH M，KIECHL S，et al．Stroke thrombolysis：having more time translates into delayed therapy：data from the Austrian Stroke Unit Registry［J］．Stroke，2010，41（9）：2001-2004．DOI：10.1161/STROKEAHA.110.590372.
［73］SAVER J L，SMITH E E，FONAROW G C，et al．The "golden hour" and acute brain ischemia：presenting features and lytic therapy in >30 000 patients arriving within 60 minutes of stroke onset［J］．Stroke，2010，41（7）：1431-1439．DOI：10.1161/STROKEAHA.110.583815.
［74］GC F，EE S，JL S，et al．Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke：patient characteristics，hospital factors，and outcomes associated with door-to-needle times within 60 minutes［J］．Circulation，2011，123（7）：750-758．DOI：10.1161/CIRCULATIONAHA.110.974675.
［75］何霞婷，褚安红．急诊专业组护士对急性脑卒中患者诊疗时间的影响［C］//中华医学会急诊医学分会．中华医学会急诊医学分会第十六次全国急诊医学学术年会论文集，2013：353.
［76］胡敏，汤淑敏，常杰，等．急性脑梗死患者急诊溶栓流程优化的品管圈实践［J］．护理学报，2015，22（7）：19-22．DOI：10.16460/j.issn1008-9969.2015.07.019.
HU M，TANG S M，CHANG J，et al．Quality control circle in process optimization of emergency thrombolytic therapy for patients with acute cerebral infarction［J］．Journal of Nursing，2015，22（7）：19-22．DOI：10.16460/j.issn1008-9969.2015.07.019.
［77］张萍，张婷婷，于龙娟，等．卒中急救护士对急性缺血性卒中救治效率的影响［J］．中国卒中杂志，2018，13（5）：425-429．DOI：10.3969/j.issn.1673-5765.2018.05.004.
ZHANG P，ZHANG T T，YU L J，et al．Impact of stroke nurses on treatment effciency of acute ischemic stroke［J］．Chin J Stroke，2018，13（5）：425-429．DOI：10.3969/j.issn.1673-5765.2018.05.004.

[1]	XU Baichuan, WANG Yan, ZHANG Peng, LI Yiting, LIU Feilai, XIE Yang. Research and Analysis of Screening Tools for Chronic Obstructive Pulmonary Disease Comorbidity Lung Cancer [J]. Chinese General Practice, 2025, 28(30): 3847-3852.
[2]	SHAO Xiaoying, SHAO Jie, ZHU Yan, SHAO Jinling, SHANG Ling, WU Zhenlian, ZHAO Yu, ZHANG Jiacai. Analysis of the Current Status of Iron Deficiency and Factors Affecting Iron Deficiency Anemia among Children Aged 6-36 Months in Guizhou Province [J]. Chinese General Practice, 2025, 28(27): 3368-3374.
[3]	ZHOU Qian, WU Xiaomin, WANG Baohua, YAN Ruohan, YU Miao, WU Jing. Study on Nomogram Prediction Model for Risk of Gastric Cancer [J]. Chinese General Practice, 2025, 28(23): 2870-2877.
[4]	YANG Ji, ZHANG Yao, ZHAO Yingqiang, ZHANG Qiuyue. Evaluation of the Effectiveness of TCM Three-level Prevention and Control Model in the Management of Patients with Coronary Heart Disease and Stroke: a Single-center, Prospective Cohort Study [J]. Chinese General Practice, 2025, 28(22): 2750-2761.
[5]	GUO Shengteng, ZHANG Fenfen, WAN Di, YU Dongmei, WANG Qinghua. Risk Factors for Severe Acute Pancreatitis Complicated with Acute Lung Injury: a Meta-analysis [J]. Chinese General Practice, 2025, 28(20): 2546-2554.
[6]	TAN Yi, ZHU Lihong, YIN Zengwei, HOU Shunan, YU Houming. A Real-world Study of MRI-guided Intravenous Thrombolytic Therapy in Acute Ischemic Stroke [J]. Chinese General Practice, 2025, 28(20): 2508-2515.
[7]	CHU Tianyu, GU Yan. Carotid Artery Calcification Features in Plaque Stability and Clinical Events [J]. Chinese General Practice, 2025, 28(18): 2247-2252.
[8]	TAN Wenbin, LI Jia, LIU Mingyu, LU Yongxin, CHENG Yaxin. Research Progress on the Influence of Nervous System Diseases and Related Therapeutic Drugs on Osteoporosis [J]. Chinese General Practice, 2025, 28(17): 2092-2100.
[9]	LI Mei, JIANG Dongsheng, ZHAO Jingjing, CAO Yajing, ZHANG Fan, TANG Lijuan, LIU Xiaoli. Correlation Analysis of Homocysteine and Stroke in People over 40 Years Old [J]. Chinese General Practice, 2025, 28(14): 1723-1729.
[10]	WANG Xiaoyu, FENG Zhenzhen, WANG Jun, GUO Xiaochuan, LI Jiansheng. Risk Factors for Acute Kidney Injury in Acute Respiratory Distress Syndrome: a Systematic Review [J]. Chinese General Practice, 2025, 28(12): 1527-1537.
[11]	ZHAO Zhixin, MEI Yongxia, WANG Xiaoxuan, JIANG Hu, WANG Wenna, ZHANG Zhenxiang. Cognition and Experience of Social Participation in Stroke Survivors: a Meta-synthesis Based on Qualitative Studies [J]. Chinese General Practice, 2025, 28(10): 1273-1280.
[12]	LIAO Xingyu, TIAN Siyu, CHEN Min. The Disease Burden, Risk Factors and Predictive Analysis of Early-onset Colorectal Cancer of Different Genders between China and the World from 1990 to 2021 [J]. Chinese General Practice, 2025, 28(08): 1004-1011.
[13]	ZOU Songyan, ZHANG Riyi, LI Xiaodong, MU Yinyu. Analysis of Clinical Characteristics and Risk Factors of Systemic Sclerosis Combined with Sjögren's Syndrome [J]. Chinese General Practice, 2025, 28(06): 737-741.
[14]	LIU Zuting, XU Minghuan, YANG Xuezhi, MO Jiali, LIU Xingyu, DU Huijie, ZHANG Huiqin, YI Yingping, KUANG Jie. Correlation between the Systemic Inflammatory Response Index and Risk of Ischemic Stroke Recurrence [J]. Chinese General Practice, 2025, 28(05): 541-547.
[15]	SHI Xiaotian, WANG Shan, YANG Huayu, YANG Yifan, LI Xu, DOU Guoze, MA Qing. A Predictive Nomogram for the Risk of Frailty/Pre-frailty on Inflammatory Biomarkers in the Elderly [J]. Chinese General Practice, 2025, 28(05): 587-593.