Department of Neurology, Okumenisches Hainich Klinikum Mühlhausen, Thüringen, Germany.
Eur J Neurol. 2010 Apr;17(4):555-61. doi: 10.1111/j.1468-1331.2009.02845.x. Epub 2010 Feb 10.
Since doubts were raised, if a challenging medical procedure such as acute stroke treatment including thrombolysis with recombinant tissue plasminogen activator (rTPA) is available with identical standard and outcome 24 h and 7 days a week our aim was to examine if acute stroke patients defined by onset-admission time (OAT) of <or= 3 h were treated differently or had distinct outcome when admitted during off duty hours (day versus night and weekend versus weekdays) and if any differences in treatment or outcome were apparent when comparing patients admitted in the year 2003 with patients admitted in the year 2006.
We analyzed 2003-2006 data of a prospective registry and grouped patients by time, day, and year of admission. The evaluation was limited to patients that were diagnosed with ischaemic stroke and with OAT of <or= 3 h. Medical and sociodemographic items, use of thrombolytic treatment, complications during clinical course and place of discharge were obtained. Clinical state on admission and discharge was assessed using the modified Rankin scale. Comparison with chi-square test, t-test and logistic regression was performed.
Patient's characteristics, rate of thrombolysis, and outcome were independent from time or day of admission. Proportion of patients with good clinical state at discharge increased significantly from 2003 to 2006 together with a higher rate of rTPA treatment without increase of intracranial hemorrhage. Proportion of patients discharged in good clinical condition after rTPA treatment increased from 34% to 44%.
Stroke treatment in potential candidates for thrombolytic therapy revealed no impairment on weekend or at night already in 2003. During 4 years, it was possible to increase rate of rTPA treatment from 8.9% to 21.8% without increment of complications or death, confirming that rTPA is safe and can be implemented with full daily and weekly coverage.
自从出现了质疑，即如果每周 24 小时、每天都能提供有挑战性的医疗程序，如急性脑卒中溶栓治疗（包括重组组织纤溶酶原激活剂[rTPA]），其标准和结果是否相同，我们的目的是研究发病到入院时间（OAT）＜3 小时的急性脑卒中患者，在非工作时间（白天与夜间、周末与工作日）入院时，是否接受不同的治疗或有不同的结果，以及在比较 2003 年和 2006 年入院的患者时，治疗或结果是否有明显差异。
我们分析了前瞻性登记的 2003-2006 年的数据，并按时间、白天和入院年份对患者进行分组。评估仅限于诊断为缺血性脑卒中且 OAT＜3 小时的患者。获取患者的医疗和社会人口学项目、溶栓治疗的使用、临床病程中的并发症以及出院地点等信息。入院和出院时的临床状态采用改良 Rankin 量表进行评估。采用卡方检验、t 检验和逻辑回归进行比较。
患者特征、溶栓率和结局与入院时间或白天无关。出院时临床状态良好的患者比例从 2003 年到 2006 年显著增加，同时 rTPA 治疗的比例增加，而颅内出血没有增加。rTPA 治疗后出院时临床状态良好的患者比例从 34%增加到 44%。
在 2003 年，已经有研究表明溶栓治疗的潜在候选患者在周末或夜间治疗并没有受到影响。在 4 年期间，rTPA 治疗的比例从 8.9%增加到 21.8%，而并发症或死亡没有增加，这证实了 rTPA 是安全的，并且可以每天和每周全面实施。
