Chen Chin-I, Iguchi Yasuyuki, Grotta James C, Garami Zsolt, Uchino Ken, Shaltoni Hashem, Alexandrov Andrei V
Stroke Treatment Team, The University of Texas, Houston, USA.
Eur Neurol. 2005;54(3):140-4. doi: 10.1159/000089086. Epub 2005 Oct 18.
Although thrombolysis in patients with advanced age is considered more risky, some may benefit from TPA treatment. We studied safety and recanalization/recovery in patients older than 80 years treated with TPA and compared them with younger stroke patients.
We studied patients treated with intravenous TPA and divided them into younger (<80 years) and older (> or =80 years) groups for comparison. Diagnostic transcranial Doppler was completed before bolus, and patients were consequently monitored for up to 2 h when feasible. Clinical data included NIH Stroke Scale score, symptomatic intracranial hemorrhage (ICH) and discharge disposition.
We studied 127 younger (mean 63 years, range 31-79) and 56 older patients (mean 84 years, range 80-93). Median baseline NIH Stroke Scale score was higher in the older group (18 vs. 14 points, NS). Occlusion locations, onset to needle time (median 130 vs. 120 min) as well as improvement at 24 h (median 5 vs. 4 points) were similar in both groups. Transcranial Doppler monitoring showed similar partial or complete recanalization rates (66 vs. 66%), onset to recanalization time (median 160 vs. 158 min) and reocclusion rates (26 vs. 25%). Symptomatic and fatal ICH was not higher in the older group (7.1 and 3.5% vs. 6.3 and 3.9%, NS). There was higher mortality among older patients (20 vs. 11%, NS). At discharge, 23% of older patients went home, 41% underwent rehabilitation and 16% were transferred to skilled nursing facilities, compared with 31, 43 and 15% respectively, in the younger group.
After intravenous TPA treatment, patients over 80 years of age have similar recanalization, short-term improvement and symptomatic ICH rates compared with younger patients. However, older patients tend to have higher in-hospital mortality.
尽管高龄患者溶栓被认为风险更高，但部分患者可能从组织型纤溶酶原激活剂（TPA）治疗中获益。我们研究了接受TPA治疗的80岁以上患者的安全性及再通/恢复情况，并将其与年轻的卒中患者进行比较。
我们研究了接受静脉TPA治疗的患者，并将其分为年轻组（<80岁）和老年组（≥80岁）进行比较。在推注前完成诊断性经颅多普勒检查，可行时对患者进行长达2小时的监测。临床数据包括美国国立卫生研究院卒中量表评分、症状性颅内出血（ICH）及出院处置情况。
我们研究了127名年轻患者（平均63岁，范围31 - 79岁）和56名老年患者（平均84岁，范围80 - 93岁）。老年组的基线美国国立卫生研究院卒中量表评分中位数更高（18分对14分，无显著性差异）。两组的闭塞部位、穿刺时间（中位数130分钟对120分钟）以及24小时时的改善情况（中位数5分对4分）相似。经颅多普勒监测显示两组的部分或完全再通率相似（66%对66%）、再通时间（中位数160分钟对158分钟）及再闭塞率相似（26%对25%）。老年组的症状性及致命性ICH发生率并不更高（7.1%和3.5%对6.3%和3.9%，无显著性差异）。老年患者的死亡率更高（20%对11%，无显著性差异）。出院时，23%的老年患者回家，41%接受康复治疗，16%被转至专业护理机构，而年轻组分别为31%、43%和15%。
静脉注射TPA治疗后，80岁以上患者与年轻患者相比，再通率、短期改善情况及症状性ICH发生率相似。然而，老年患者的院内死亡率往往更高。
