Department of Physical Medicine, POB 24035, Hadassah-Hebrew University Medical Center, Jerusalem, 91240 Israel.
PM R. 2010 Aug;2(8):698-702; quiz 792. doi: 10.1016/j.pmrj.2010.04.029.
To investigate the influence of thrombolysis on functional outcomes after rehabilitation.
Systemic thrombolysis with tissue plasminogen activator (tPA) is considered the mainstay of acute stroke therapy and was found to improve short-term outcome.
Matched case-controlled design.
Inpatient neurology and rehabilitation departments.
Thirty-seven patients given tPA and 37 control patients not treated with lytics because of protocol limits.
We retrospectively analyzed data from a cohort of stroke patients who were treated with systemic tPA. The rehabilitation outcome of thrombolysis-treated patients was compared with that observed for tPA-ineligible and age- and stroke severity-matched patients treated at the same neurology and rehabilitation departments.
Neurological evaluation was assessed with the National Institutes of Health stroke scale (NIHSS). Activity of daily living was measured using the Functional Independence Measure (FIM) instrument. Functional outcome was measured using the modified Rankin scale (mRS).
The treatment group included 37 patients given tPA; 37 tPA-ineligible patients served as controls. On admission to rehabilitation, there were no significant differences in functional, neurological, and rehabilitation parameters between the groups. At the end of the rehabilitation period, NIHSS scores were significantly lower in the thrombolysis group (P = .036). More patients in the thrombolysis group reached functional independence defined as mRS < or =2 (20/37 versus 10/37; P = .03). At the end of rehabilitation, total FIM score (mean 102.8 versus 93.9; P = .039), total FIM gain (mean 27.8 versus 21.4; P = .09), and total FIM efficiency scores (0.8 versus 0.43; P = .013) were higher in the thrombolysis group and more patients in this group were discharged home.
Although the bulk of neurological improvement occurred before the inpatient rehabilitation, thrombolysis-treated patients continue to improve faster and to a larger extent during the rehabilitation period suggesting that the beneficial effects of thrombolysis continue beyond the acute phase.
研究溶栓治疗对康复后功能结局的影响。
组织型纤溶酶原激活物（tPA）全身溶栓被认为是急性脑卒中治疗的主要手段，并已被证实可改善短期预后。
配对病例对照设计。
神经内科和康复科住院部。
37 例接受 tPA 溶栓治疗的患者和 37 例因方案限制未接受溶栓治疗的对照组患者。
我们回顾性分析了一组接受全身 tPA 溶栓治疗的脑卒中患者的数据。将溶栓治疗患者的康复结果与在同一神经内科和康复科接受治疗、但不适合 tPA 治疗且年龄和脑卒中严重程度相匹配的患者的观察结果进行比较。
采用国立卫生研究院卒中量表（NIHSS）评估神经功能评估。采用功能独立性测量（FIM）工具评估日常生活活动能力。采用改良 Rankin 量表（mRS）评估功能结局。
治疗组包括 37 例接受 tPA 溶栓治疗的患者；37 例不适合 tPA 治疗的患者作为对照组。入康复科时，两组在功能、神经和康复参数方面无显著差异。康复期末，溶栓组 NIHSS 评分显著降低（P =.036）。溶栓组更多患者达到功能独立性（mRS < or =2）（20/37 例 vs 10/37 例；P =.03）。康复期末，总 FIM 评分（平均 102.8 分 vs 93.9 分；P =.039）、总 FIM 增益（平均 27.8 分 vs 21.4 分；P =.09）和总 FIM 效率评分（0.8 分 vs 0.43；P =.013）均较高，且该组更多患者出院回家。
尽管大部分神经改善发生在住院康复之前，但溶栓治疗组在康复期间仍继续更快、更大程度地改善，提示溶栓的益处持续至急性期之后。
