Wiegand Nico, Lüthy Regina, Vogel Barbara, Straumann Ediwin, Beynon Christopher, Bertel Osmund, Oelz Oswald, Caspar Clemens B
Department of Internal Medicine, Triemli Hospital, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland.
Swiss Med Wkly. 2004 Jan 10;134(1-2):14-7. doi: 10.4414/smw.2004.10301.
Treatment with intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) is recommended for selected patients with acute ischaemic stroke. We evaluated the feasibility and safety of this treatment in clinical practice in a hospital without a specialised neuro-intensive care unit.
We prospectively studied all patients who were treated with i.v. rt-PA for ischaemic stroke at our hospital between January 2001 and June 2002. The selection criteria corresponded to those published by the NINDS [1] and ECASS [2] groups. Time intervals between stroke symptom onset, hospital arrival and treatment with rt-PA were measured. A modified NIH stroke scale was used to assess clinical outcome 24 hours after stroke onset and before discharge. Cerebral computed tomography was performed prior to thrombolysis and again if the neurological status failed to improve or deteriorated.
Thrombolytic therapy was administered to 15 acute ischaemic stroke patients, 13 men and two women with a median age of 69 years. The median time from stroke onset to rt-PA therapy was 135 minutes and from arrival in the emergency room to the start of thrombolysis 74 minutes. Ten patients exhibited early clinical improvement, defined as a decrease in NIHSS score by 4 points at 24 hours. Further improvement until discharge was observed in nine of these ten patients. One patient developed a non-fatal intracerebral haemorrhage. Another patient with severe stroke and clinical failure of thrombolysis died after 25 days.
This study in a small patient population suggests that thrombolysis with rt-PA for acute ischaemic stroke is feasible without excess risk in a hospital experienced in the management of stroke patients, with a neurological consultant service but without a specialised neuro-intensive care unit (NICU). The outcome in this small series of patients corresponds to the results described in the randomised trials.
对于部分急性缺血性卒中患者，推荐采用静脉注射重组组织型纤溶酶原激活剂（rt-PA）进行治疗。我们评估了在一家没有专业神经重症监护病房的医院中，这种治疗方法在临床实践中的可行性和安全性。
我们前瞻性研究了2001年1月至2002年6月期间在我院接受静脉注射rt-PA治疗缺血性卒中的所有患者。入选标准与美国国立神经疾病和卒中研究所（NINDS）[1]及欧洲急性卒中协作研究（ECASS）[2]小组公布的标准一致。测量了卒中症状发作、入院与rt-PA治疗之间的时间间隔。采用改良的美国国立卫生研究院卒中量表（NIHSS）评估卒中发作24小时后及出院前的临床结局。在溶栓治疗前及神经功能状态未改善或恶化时再次进行头颅计算机断层扫描（CT）。
对15例急性缺血性卒中患者进行了溶栓治疗，其中13例男性，2例女性，中位年龄69岁。从卒中发作到rt-PA治疗的中位时间为135分钟，从到达急诊室到开始溶栓的时间为74分钟。10例患者出现早期临床改善，定义为24小时时NIHSS评分降低4分。这10例患者中有9例在出院前进一步改善。1例患者发生非致命性脑出血。另1例严重卒中且溶栓治疗临床失败的患者在25天后死亡。
这项针对少量患者的研究表明，在一家有卒中患者管理经验、有神经科会诊服务但没有专业神经重症监护病房（NICU）的医院中，采用rt-PA对急性缺血性卒中进行溶栓治疗是可行的，且不存在额外风险。这一小系列患者的结局与随机试验中描述的结果相符。
