Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland.
Stroke. 2012 Apr;43(4):1039-45. doi: 10.1161/STROKEAHA.111.630384. Epub 2012 Mar 8.
Thrombolysis improves outcome of patients with acute ischemic stroke, but it is unknown whether thrombolysis has a measurable effect on long-term outcome in a defined population.
We prospectively assessed demographic data, management, and outcome of acute ischemic stroke patients admitted within 48 hours to 18 primary care hospitals of the canton of Bern (969 299 inhabitants) during 12 months. Blinded follow-up was obtained at 3 and 12 months. Predictors of mortality and favorable outcome (modified Rankin Scale score ≤2) at 3 and 12 months using logistic regression were analyzed.
From December 2007 to December 2008, 807 patients (mean age, 72 years) were included. Median National Institutes of Health Stroke Scale score on admission was 5; 107 patients (13%) received intravenous, intra-arterial, or mechanical thrombolysis. Estimated cumulative mortality at 3 months was 20.6% and at 12 months 27.4%. Age 75 years or older, higher National Institutes of Health Stroke Scale scores, and higher Charlson comorbidity index were independent predictors of mortality at 3 and 12 months. Estimated favorable outcome at 3 months was 48.2% and at 12 months was 44.6%. Thrombolysis was the only modifiable independent predictor of favorable outcome at 3 (relative risk, 1.49; 95% CI, 1.18-1.89) and 12 months (relative risk, 1.59; 95% CI, 1.24-2.04), whereas age younger than 75 years, male gender, National Institutes of Health Stroke Scale score <4, and lower Charlson comorbidity index were nonmodifiable predictors.
Thirteen percent of acute ischemic stroke patients admitted within 48 hours to Bernese hospitals underwent thrombolysis, which exerted a measurable effect on 3-month outcome in this population. This effect was sustained at 12 months. Age, stroke severity, Charlson comorbidity index, and male gender were independent nonmodifiable predictors of outcome.
溶栓治疗可改善急性缺血性脑卒中患者的预后，但在特定人群中，溶栓治疗对长期预后是否有可衡量的影响尚不清楚。
我们前瞻性评估了在 12 个月内，伯尔尼州 18 家初级保健医院（969299 名居民）收治的发病 48 小时内的急性缺血性脑卒中患者的人口统计学数据、治疗方法和结局。在 3 个月和 12 个月时进行盲法随访。采用逻辑回归分析了 3 个月和 12 个月时死亡率和良好结局（改良 Rankin 量表评分≤2）的预测因素。
2007 年 12 月至 2008 年 12 月，共纳入 807 例患者（平均年龄 72 岁）。入院时中位 NIHSS 评分为 5 分；107 例（13%）患者接受了静脉、动脉内或机械溶栓治疗。3 个月时的估计累积死亡率为 20.6%，12 个月时为 27.4%。75 岁或以上、较高的 NIHSS 评分和较高的 Charlson 合并症指数是 3 个月和 12 个月时死亡率的独立预测因素。3 个月时的估计良好结局为 48.2%，12 个月时为 44.6%。溶栓治疗是 3 个月（相对风险，1.49；95%CI，1.18-1.89）和 12 个月（相对风险，1.59；95%CI，1.24-2.04）时唯一可改变的独立预后预测因素，而年龄<75 岁、男性、NIHSS 评分<4 分和较低的 Charlson 合并症指数是不可改变的预测因素。
伯尔尼州医院收治的发病 48 小时内的急性缺血性脑卒中患者中，有 13%接受了溶栓治疗，该治疗在该人群中对 3 个月的预后有可衡量的影响。这种影响在 12 个月时仍持续存在。年龄、卒中严重程度、Charlson 合并症指数和男性是独立的不可改变的预后预测因素。
