Division of Neurology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
J Stroke Cerebrovasc Dis. 2012 Jan;21(1):42-6. doi: 10.1016/j.jstrokecerebrovasdis.2010.03.017. Epub 2010 Jun 17.
Some of the literature encourages the use of intravenous (IV) thrombolytic therapy for acute ischemic stroke (AIS) in centers with no previous experience with this therapy. The benefits of an acute stroke referral network for IV thrombolytic therapy remain controversial, however. We present outcomes of IV thrombolytic therapy for AIS with an integrated acute stroke referral network at an institution with no previous experience in stroke thrombolysis and compare the results with previously published data. A total of 458 patients with AIS or transient ischemic attack (TIA), referred from a hospital in the acute stroke referral network or walk-ins, admitted to the stroke unit of Thammasat Hospital between October 2007 and January 2009 (16 months) were prospectively assessed. The main outcome measures were IV thrombolytic treatment rate, initial National Institutes of Health Stroke Scale (NIHSS) score, door-to-needle time, onset-to-treatment time (OTT), intracerebral hemorrhage, and morbidity and mortality at 3 months after onset. A total of 100 patients (59 from hospitals in the stroke referral network) received IV recombinant tissue plasminogen activator (rt-PA) therapy (21% of the admissions with AIS and TIA); 41% of the patients referred from a hospital in the network received IV rt-PA. The median NIHSS score before thrombolysis was 15 (range, 3-34). Mean door-to-needle time was 54 minutes (range, 15-125 minutes), and mean OTT was 160 minutes (range, 60-270 minutes). There were 13 asymptomatic intracerebral hemorrhages and 2 symptomatic intracerebral hemorrhages (1 fatal). By 3 months, 42 patients had achieved excellent recovery (modified Rankin Scale score of 0-1), and 14 had died. These outcomes are comparable to data from the National Institute of Neurological Disorders and Stroke and previous studies of IV rt-PA therapy in Thailand. Our findings indicate that integrating an acute stroke referral network into IV thrombolytic therapy for AIS in a community-based setting is safe and feasible and should help increase the rate of thrombolytic therapy. Previously inexperienced community-based centers can reproduce the experience and outcome measures reported by clinical trials and in the landmark literature of IV thrombolytic therapy in patients with stroke.
一些文献鼓励在没有使用过这种治疗方法的中心使用静脉内（IV）溶栓治疗急性缺血性脑卒中（AIS）。然而，急性脑卒中转诊网络对 IV 溶栓治疗的益处仍存在争议。我们在一家没有脑卒中溶栓经验的机构中展示了通过急性脑卒中转诊网络进行 IV 溶栓治疗的结果，并将结果与之前发表的数据进行了比较。2007 年 10 月至 2009 年 1 月（16 个月）期间，共有 458 例 AIS 或短暂性脑缺血发作（TIA）患者从急性脑卒中转诊网络中的一家医院或直接就诊于 Thammasat 医院的脑卒中病房，前瞻性评估了他们的情况。主要结局测量指标包括 IV 溶栓治疗率、初始国立卫生研究院脑卒中量表（NIHSS）评分、门到针时间、发病到治疗时间（OTT）、颅内出血以及发病后 3 个月的发病率和死亡率。共有 100 例患者（59 例来自脑卒中转诊网络中的医院）接受了 IV 重组组织型纤溶酶原激活剂（rt-PA）治疗（AIS 和 TIA 患者入院人数的 21%）；41%的网络转诊患者接受了 IV rt-PA 治疗。溶栓前的中位数 NIHSS 评分为 15（范围 3-34）。平均门到针时间为 54 分钟（范围 15-125 分钟），平均 OTT 为 160 分钟（范围 60-270 分钟）。有 13 例无症状性颅内出血和 2 例症状性颅内出血（1 例死亡）。3 个月时，42 例患者实现了极好的恢复（改良 Rankin 量表评分为 0-1），14 例患者死亡。这些结果与美国国立神经病学和卒中研究所的数据以及之前在泰国进行的 IV rt-PA 治疗的研究结果相当。我们的发现表明，在社区环境中整合急性脑卒中转诊网络用于 AIS 的 IV 溶栓治疗是安全可行的，应该有助于提高溶栓治疗率。以前没有经验的社区中心可以复制临床试验和 IV 溶栓治疗脑卒中患者标志性文献中报告的经验和结局测量指标。
