静脉注射组织型纤溶酶原激活物溶栓治疗可预测急性缺血性脑卒中患者出院时的良好转归。
Thrombolysis with intravenous tissue plasminogen activator predicts a favorable discharge disposition in patients with acute ischemic stroke.
机构信息
Department of Neurology, University of Texas Houston Medical School, 6431 Fannin, MSB 7.044, Houston, TX 77030, USA.
出版信息
Stroke. 2011 Mar;42(3):700-4. doi: 10.1161/STROKEAHA.110.604108. Epub 2011 Feb 3.
BACKGROUND AND PURPOSE
Acute ischemic stroke patients who receive recombinant tissue plasminogen activator (rt-PA) within 3 hours of symptom onset are 30% more likely to have minimal to no disability at 3 months. During hospitalization, short-term disability is subjectively measured by discharge disposition, whether to home, inpatient rehabilitation, a skilled nursing facility, or subacute care. There are no studies assessing the role of recombinant tissue plasminogen activator use as a predictor of poststroke discharge disposition.
METHODS
We conducted a retrospective analysis of all patients with ischemic stroke who presented within the original three hour window for intravenous thrombolysis, and who were admitted to the University of Texas Houston Medical School Stroke Service at Memorial Hermann Hospital - Texas Medical Center between January 2004 and October 2009. Baseline demographics and National Institute of Health Stroke Scale score were collected. Cerebrovascular disease risk factors were used for risk stratification in the multivariate regression.
RESULTS
Out of 2225 patients with acute ischemic stroke, 1019 were discharged to home, 719 to inpatient rehabilitation, 371 to a skilled nursing facility and 116 to subacute care. Patients who received recombinant tissue plasminogen activator therapy were more likely to be discharged home compared to the other levels of care (P<0.0001; OR, 1.945; 95% CI, 1.538 to 2.459). Considering post-acute inpatient rehabilitation versus skilled nursing facility/subacute care and disposition at a skilled nursing facility versus subacute care, there were no differences in disposition between patients who received recombinant tissue plasminogen activator therapy. Inpatient Rehabilitation versus Skilled Nursing Facility or Subacute Care (P = 0.123); Skilled Nursing Facility versus Subacute Care (P = 0.605).
CONCLUSIONS
Patients who receive intravenous recombinant tissue plasminogen activator as treatment for acute ischemic stroke are more likely to be discharged directly home after hospitalization. This study is limited by its retrospective nature and the undetermined role of psychosocial factors related to discharge.
背景与目的
在症状出现后 3 小时内接受重组组织型纤溶酶原激活剂（rt-PA）治疗的急性缺血性脑卒中患者，3 个月后达到最小或无残疾的可能性增加 30%。在住院期间，短期残疾通过出院安置来主观衡量，即是否出院回家、住院康复、熟练护理设施或亚急性护理。目前尚无研究评估重组组织型纤溶酶原激活剂的使用作为卒中后出院安置预测因子的作用。
方法
我们对 2004 年 1 月至 2009 年 10 月期间在德克萨斯大学休斯顿医学院纪念赫尔曼医院德克萨斯医疗中心的静脉溶栓原始 3 小时窗口内就诊的所有缺血性脑卒中患者进行了回顾性分析。收集了基线人口统计学和 NIHSS 评分。脑血管病危险因素用于多变量回归中的风险分层。
结果
在 2225 例急性缺血性脑卒中患者中，1019 例出院回家，719 例出院至住院康复，371 例出院至熟练护理设施，116 例出院至亚急性护理。与其他护理水平相比，接受重组组织型纤溶酶原激活剂治疗的患者更有可能出院回家（P<0.0001；OR，1.945；95%CI，1.538 至 2.459）。考虑到急性后住院康复与熟练护理设施/亚急性护理的区别以及熟练护理设施与亚急性护理的区别，接受重组组织型纤溶酶原激活剂治疗的患者在出院安置方面没有差异。住院康复与熟练护理设施或亚急性护理（P=0.123）；熟练护理设施与亚急性护理（P=0.605）。
结论
接受急性缺血性脑卒中静脉重组组织型纤溶酶原激活剂治疗的患者在住院后更有可能直接出院回家。本研究受到其回顾性性质以及与出院相关的不确定社会心理因素的限制。
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