LaMonte Marian P, Bahouth Mona N, Magder Laurence S, Alcorta Richard L, Bass Robert R, Browne Brian J, Floccare Douglas J, Gaasch Wade R
Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
Ann Emerg Med. 2009 Sep;54(3):319-27. doi: 10.1016/j.annemergmed.2008.09.022. Epub 2008 Dec 19.
Administration of tissue plasminogen activator (tPA) for acute ischemic stroke remains controversial in community practice. Well-organized hierarchic systems of acute stroke care have been proposed to link community hospitals to comprehensive stroke centers. We report safety and functional outcomes in patients treated with tPA in our regional emergency stroke network and compare them with results reported from the trial conducted by the National Institute of Neurological Disorders and Stroke (NINDS).
Through a statewide communications and transport network, our brain attack center gives emergency medicine staff in the state and surrounding area immediate access to stroke specialists. The team provides consultation about the administration of tPA for ischemic stroke, using the NINDS protocol. Consultations, treatment, and outcomes are documented in our database.
From 1996 to 2005, the brain attack center completed 2,670 consultations and diagnosed 1,788 patients with ischemic stroke. Two hundred forty patients (9% of all consultations; 13.4% of those with acute ischemic stroke) received tPA. Percentages of patients with symptomatic intracranial hemorrhage and 3-month modified Rankin scale scores less than or equal to 1, compared with those in the NINDS trial, were as follows: 3.3% versus 6.4% and 53% versus 43% (P=.04). Mortality rates were 13% (network) versus 17% (NINDS).
During a 9-year period, an emergency medicine network with stroke consultants achieved patient outcomes comparable to those reported from the NINDS trial. These results indicate that the NINDS tPA protocol is applicable to community practice, with the support of a university-based brain attack center.
在社区医疗实践中，使用组织型纤溶酶原激活剂（tPA）治疗急性缺血性脑卒中仍存在争议。有人提议建立组织完善的急性脑卒中护理分级系统，将社区医院与综合性脑卒中中心联系起来。我们报告了在我们地区的急诊脑卒中网络中接受tPA治疗的患者的安全性和功能转归，并将其与美国国立神经疾病与卒中研究所（NINDS）进行的试验结果进行比较。
通过一个全州范围的通信和转运网络，我们的脑卒中介入中心使该州及周边地区的急救医护人员能够直接联系到脑卒中专家。该团队使用NINDS方案，就tPA治疗缺血性脑卒中提供咨询。咨询、治疗及转归情况均记录在我们的数据库中。
1996年至2005年，脑卒中介入中心完成了2670次咨询，诊断出1788例缺血性脑卒中患者。240例患者（占所有咨询的9%；占急性缺血性脑卒中患者的13.4%）接受了tPA治疗。与NINDS试验相比，有症状性颅内出血患者的百分比以及3个月改良Rankin量表评分小于或等于1分的患者百分比分别如下：3.3%对6.4%以及53%对43%（P = 0.04）。死亡率分别为13%（本网络）对17%（NINDS）。
在9年期间，一个配备脑卒中咨询专家的急救医疗网络所取得的患者转归与NINDS试验报告的结果相当。这些结果表明，在一个以大学为基础的脑卒中介入中心的支持下，NINDS的tPA方案适用于社区医疗实践。
