Kappelle L J, van der Worp H B
Afd. Neurologie, Universitair Medisch Centrum Utrecht.
Ned Tijdschr Geneeskd. 2000 May 27;144(22):1025-8.
In four patients with symptoms of presumed acute ischaemic stroke intravenous treatment with recombinant tissue plasminogen activator (rtPA) was considered. Two patients indeed received rtPA within 3 hours after onset of symptoms. One of them, a 55-year-old woman, recovered and was able to resume her job as a teacher four months later. The other patient, a 38-year-old man, had a severe bleeding complication that could be stopped, but the patient died several days later because of the massive stroke. The third patient, an 82-year-old woman, could not be treated with rtPA because the time of onset of neurological deficit was uncertain. Nevertheless, she recovered well from her hemiplegia after a few days. The fourth patient, a 24-year-old woman, did not receive rtPA because her symptoms were thought to be the result of a psychogenic disorder. Intravenous thrombolysis increases the risk of intracranial haemorrhage, but should be considered a useful treatment for ischaemic stroke provided there is no doubt about this diagnosis and treatment with rtPA can be started within 3 hours of onset of the neurological deficit.
对于4例疑似急性缺血性卒中症状的患者，考虑采用重组组织型纤溶酶原激活剂（rtPA）进行静脉治疗。其中2例患者在症状发作后3小时内确实接受了rtPA治疗。其中1例是一名55岁女性，恢复良好，4个月后能够重新担任教师工作。另1例患者是一名38岁男性，出现了严重的出血并发症，虽经治疗出血得以控制，但该患者几天后因大面积卒中死亡。第3例患者是一名82岁女性，由于神经功能缺损的发作时间不确定，无法接受rtPA治疗。然而，几天后她的偏瘫恢复良好。第4例患者是一名24岁女性，未接受rtPA治疗，因为她的症状被认为是精神性障碍所致。静脉溶栓会增加颅内出血的风险，但如果对缺血性卒中的诊断毫无疑问且能在神经功能缺损发作后3小时内开始使用rtPA治疗，那么静脉溶栓应被视为一种有效的治疗方法。
