Vaishnav Anand G, Pettigrew L Creed, Ryan Stephen
Stroke Program of the Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536-0230, USA.
Clin Neurol Neurosurg. 2008 May;110(5):451-4. doi: 10.1016/j.clineuro.2008.01.010. Epub 2008 Mar 18.
To determine the safety of telephonic guidance for use of intravenous recombinant tissue plasminogen activator (IV rtPA) in rural hospitals.
We performed a retrospective survey of 123 consecutive patients treated with IV rtPA for acute ischemic stroke (AIS) in rural hospitals between November 2003 and September 2006 and subsequently transferred to a tertiary medical center. Selection for treatment was performed by a stroke neurologist who conducted a structured telephone interview of the requesting physician. Primary outcome measures included symptomatic intracerebral hemorrhage (ICH) and in-hospital mortality.
Elapsed time (ET) from stroke onset to community hospital arrival was 54+/-30 min. ET from stroke onset to tPA bolus was 133+/-37 min. Three patients (2.5%) had symptomatic ICH, 11 (9%) had asymptomatic ICH, 9 patients (7.5%) died. Mean length of stay was 4+/-3 days; 47% were discharged to their homes. Mean ET from stroke onset to rtPA dosage did not differ significantly from the active treatment group of the NINDS rtPA Stroke Study. Prevalence of symptomatic ICH and mortality were lower in our population.
We conclude that telephonic guidance of rtPA treatment is safe, practical, and effective in overcoming barriers for optimal care of AIS in rural communities.
确定在农村医院使用静脉注射重组组织型纤溶酶原激活剂（IV rtPA）进行电话指导的安全性。
我们对2003年11月至2006年9月期间在农村医院接受IV rtPA治疗急性缺血性卒中（AIS）并随后转至三级医疗中心的123例连续患者进行了回顾性调查。由卒中神经科医生进行治疗选择，该医生对请求治疗的医生进行结构化电话访谈。主要结局指标包括症状性颅内出血（ICH）和院内死亡率。
从卒中发作到社区医院就诊的 elapsed time（ET）为54±30分钟。从卒中发作到tPA推注的ET为133±37分钟。3例患者（2.5%）发生症状性ICH，11例（9%）发生无症状ICH，9例患者（7.5%）死亡。平均住院时间为4±3天；47%患者出院回家。从卒中发作到rtPA给药的平均ET与美国国立神经疾病与卒中研究所（NINDS）rtPA卒中研究的活性治疗组相比无显著差异。我们研究人群中症状性ICH的发生率和死亡率较低。
我们得出结论，rtPA治疗的电话指导在克服农村社区AIS最佳治疗障碍方面是安全、实用且有效的。
