May Zsolt, Kakuk Ilona, Ováry Csaba, Ricsóy Gabriella, Skopál Judit, Szegedi Norbert, Varga Dániel, Nagy Zoltán
Agyérbetegségek Országos Központja, Budapest.
Orv Hetil. 2002 Nov 3;143(44):2479-84.
The authors summarised their experiences of systemic intravenous thrombolysis using recombinant tissue-type plasminogen activator with 3 hours therapeutic window in acute ischaemic stroke.
The aim of this work was to test the safety and efficacy of systemic thrombolysis in our unselected, community-based patient population.
The mean door-to-needle time was 45 minutes, the number of bleeding complications and successful recanalisation was similar to the results of the large international trials. In spite of these facts the functional outcome of our patients turned out to be worse. Compared to the baseline characteristics of the international trials the initial neurological deficit--a well known bad prognostic parameter- and also the comorbidity of our patients was more severe.
In Hungary only patients with alarming, initial symptoms arrive quickly enough for thrombolysis to the hospital, while in most of the patients with less severe stroke symptoms the delay for hospital admission is more than 3 hours. The authors assume that with more effective patient education it might be possible to solve this problem and make thrombolysis to exert a greater impact on the effectiveness of the acute stroke therapy.
作者总结了在急性缺血性卒中治疗窗为3小时的情况下,使用重组组织型纤溶酶原激活剂进行全身静脉溶栓的经验。
本研究旨在检验在我们未经过筛选的社区患者群体中进行全身溶栓的安全性和有效性。
平均门到针时间为45分钟,出血并发症数量和血管再通成功率与大型国际试验结果相似。尽管如此,我们患者的功能结局却更差。与国际试验的基线特征相比,我们患者初始神经功能缺损(一个众所周知的不良预后参数)以及合并症更为严重。
在匈牙利,只有出现警示性初始症状的患者能足够快地到达医院进行溶栓治疗,而大多数症状较轻的卒中患者入院延迟超过3小时。作者认为,通过更有效的患者教育或许有可能解决这一问题,并使溶栓对急性卒中治疗效果产生更大影响。