Romano Jose G, Muller Nils, Merino Jose G, Forteza Alejandro M, Koch Sebastian, Rabinstein Alejandro A
Department of Neurology, University of Miami Medical School, Miami, FL 33136, USA.
Neurol Res. 2007 Oct;29(7):664-6. doi: 10.1179/016164107X240035.
To determine the causes of in-hospital delays for thrombolysis.
We performed a 4 year retrospective chart analysis of i.v. tPA-treated patients at an academic medical center. Data collected included age, stroke severity by the National Institutes of Health Stroke Scale (NIHSS) and the following time points: symptom onset, hospital arrival, computed tomography (CT), i.v. tPA order and i.v. tPA initiation of infusion.
Thirty-one cases with sufficient information for analysis were identified. Mean time from onset to arrival was 58 minutes, from arrival to brain CT was 32 minutes, and from onset to i.v. rtPA infusion was 169 minutes. The mean delay between i.v. tPA order and infusion was 32 minutes. Delay between order and administration of i.v. tPA resulted in treatment after 3 hours in 9/31 cases. An inverse relationship between early hospital arrival and delayed thrombolysis was noted. Age and stroke severity did not impact treatment times.
An unexpected delay between order and actual initiation of i.v. tPA infusion resulted in almost one-third of patients receiving thrombolytics after 3 hours from symptom onset. The cause of this delay could not be discerned by this study. The paradoxical effect between early arrival to hospital and delayed treatment may be related to a sense of urgency in those arriving close to 3 hours after onset. Critical reviews such as this permit identification of hospital delays in stroke treatment, thus allowing institution of appropriate strategies to ensure prompt treatment.
确定住院溶栓延迟的原因。
我们对一家学术医疗中心接受静脉注射组织型纤溶酶原激活剂（tPA）治疗的患者进行了为期4年的回顾性病历分析。收集的数据包括年龄、美国国立卫生研究院卒中量表（NIHSS）评估的卒中严重程度以及以下时间点：症状发作、入院、计算机断层扫描（CT）、静脉注射tPA医嘱和静脉注射tPA开始输注。
确定了31例有足够信息进行分析的病例。从发作到入院的平均时间为58分钟，从入院到脑部CT的平均时间为32分钟，从发作到静脉注射重组组织型纤溶酶原激活剂（rtPA）输注的平均时间为169分钟。静脉注射tPA医嘱与输注之间的平均延迟为32分钟。在31例病例中，有9例在静脉注射tPA医嘱与给药之间出现延迟，导致治疗在3小时后进行。观察到早期入院与延迟溶栓之间存在负相关关系。年龄和卒中严重程度对治疗时间没有影响。
静脉注射tPA医嘱与实际开始输注之间意外出现延迟，导致近三分之一的患者在症状发作3小时后才接受溶栓治疗。本研究无法查明这种延迟的原因。早期入院与延迟治疗之间的矛盾效应可能与症状发作后接近3小时入院的患者的紧迫感有关。这样的批判性审查有助于识别卒中治疗中的医院延迟情况，从而能够制定适当策略以确保及时治疗。
