McCormick Michael T, Reeves Ian, Baird Tracey, Bone Ian, Muir Keith W
Division of Clinical Neurosciences, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, G51 4TF, UK.
QJM. 2008 Apr;101(4):291-8. doi: 10.1093/qjmed/hcn002. Epub 2008 Feb 5.
Intravenous alteplase is licensed for treatment of ischaemic stroke within 3 h of onset. Up to one-third of patients in the UK present to hospital within this time window but few are treated.
To examine the effect of a stroke thrombolysis protocol on service provision for an acute stroke service in the UK, jointly run by Neurology and Medicine for the Elderly providing a comprehensive stroke service to a local population of 370,000.
Prospective observational study.
Data collected prospectively for all thrombolysis referrals over a 12-month period beginning July 2004.
One hundred and eighty-eight patients were referred for potential thrombolysis, 129 transferred, 102 had an ischaemic stroke and 49 received intravenous thrombolysis. Referral rates from primary care and accident and emergency increased after guideline dissemination. Forty-three percent of the 49 patients treated with intravenous rt-PA achieved independence (modified Rankin Scale score 0-2) at 3months.
A high proportion of ischaemic stroke patients can be treated with alteplase within 3 h of onset with organized hospital services and dissemination of a simple referral protocol to local primary and secondary care services.
静脉注射阿替普酶被批准用于缺血性卒中发病3小时内的治疗。在英国，高达三分之一的患者在此时间窗内就诊于医院，但接受治疗的患者很少。
探讨卒中溶栓方案对英国一项急性卒中服务的服务提供情况的影响，该服务由神经内科和老年医学科联合开展，为当地37万人口提供全面的卒中服务。
前瞻性观察性研究。
前瞻性收集2004年7月开始的12个月期间所有溶栓转诊患者的数据。
188例患者被转诊进行潜在溶栓治疗，129例被转诊，102例为缺血性卒中，49例接受了静脉溶栓治疗。指南发布后，初级保健机构和急诊的转诊率有所提高。49例接受静脉注射rt-PA治疗的患者中，43%在3个月时实现了独立（改良Rankin量表评分为0-2）。
通过有组织的医院服务以及向当地初级和二级保健服务机构传播简单的转诊方案，很大一部分缺血性卒中患者能够在发病3小时内接受阿替普酶治疗。
