Aging Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada.
Int J Stroke. 2012 Aug;7(6):460-4. doi: 10.1111/j.1747-4949.2011.00729.x. Epub 2012 Jan 20.
Acute administration of tissue plasminogen activator has been shown to improve immediate and long-term patient recovery after ischaemic stroke. Yet, despite widespread clinical application, many patients who receive acute tissue plasminogen activator still require inpatient rehabilitation.
This study aimed to examine the effect of tissue plasminogen activator administration on recovery among patients requiring inpatient rehabilitation after stroke in Ontario, Canada. It was hypothesized that after covariate adjustment, administration of tissue plasminogen activator would be associated with accelerated progress through inpatient rehabilitation.
Acute and rehabilitation data were retrieved from the Registry of the Canadian Stroke Network and the National Rehabilitation Reporting System for all ischaemic stroke patients admitted to an acute facility and a rehabilitation unit between July 1, 2003 and March 31, 2008. Patients were divided into two groups: those who received tissue plasminogen activator and those who were medically eligible but did not receive tissue plasminogen activator. Three rehabilitation progress indicators were compared between groups: Functional Independence Measure gain, active length of stay, and discharge destination. Indicators were modelled using multivariable generalized linear models or logistic regression as appropriate.
Patients who received tissue plasminogen activator experienced shorter active lengths of stay (log estimate ± standard error: -0·04 ± 0·01 days), and were slightly more likely to be discharged home compared to controls (adjusted odds ratio 1·35, 95% confidence interval 1·004-1·82). No differences were noted on Functional Independence Measure gain during rehabilitation.
Results suggest that tissue plasminogen activator may contribute to accelerated progress through inpatient rehabilitation; however, there is no evidence to suggest that it contributes to greater functional improvement as measured by the Functional Independence Measure.
急性组织型纤溶酶原激活物的给药已被证明可以改善缺血性卒中后患者的即时和长期恢复。然而，尽管广泛的临床应用，许多接受急性组织型纤溶酶原激活物治疗的患者仍需要住院康复。
本研究旨在检查组织型纤溶酶原激活物给药对安大略省住院康复后卒中患者恢复的影响。假设在协变量调整后，组织型纤溶酶原激活物的给药与住院康复期间的康复进展加速相关。
从加拿大卒中网络登记处和国家康复报告系统中检索了 2003 年 7 月 1 日至 2008 年 3 月 31 日期间所有入住急性设施和康复病房的缺血性卒中患者的急性和康复数据。患者分为两组：接受组织型纤溶酶原激活物治疗的患者和有医学适应证但未接受组织型纤溶酶原激活物治疗的患者。比较两组之间的三个康复进展指标：功能独立性测量（FIM）增益、活动住院时间和出院去向。使用多变量广义线性模型或逻辑回归对指标进行建模，具体取决于情况。
接受组织型纤溶酶原激活物治疗的患者活动住院时间较短（对数估计值±标准误差：-0.04±0.01 天），与对照组相比，更有可能出院回家（调整后的优势比 1.35，95%置信区间 1.004-1.82）。在康复期间，FIM 增益没有差异。
结果表明，组织型纤溶酶原激活物可能有助于加速住院康复进展；然而，没有证据表明它有助于更大的功能改善，如 FIM 所衡量的。
