Weant Kyle A, Baker Stephanie N
NC Public Health Preparedness and Response, NC Department of Health and Human Services, Raleigh, 27699, USA.
Adv Emerg Nurs J. 2012 Apr-Jun;34(2):112-21. doi: 10.1097/TME.0b013e3182542bce.
Acute stroke is a common presentation to emergency departments and is the third leading cause of death in the United States. Despite the frequency of this event, and its substantial morbidity and mortality, few therapies exist to limit the damage from this devastating diagnosis. One pharmacotherapy for ischemic stroke that has demonstrated efficacy in this setting is tissue plasminogen activator (Activase; tPA; alteplase). Current guidelines for this agent recommend its use within the first 3 hr of the onset of stroke symptoms in patients who meet specified criteria. However, more recent data have lead to recommending the extension of this time frame to 4.5 hr after onset of symptoms in specific patient populations. Although this therapy has demonstrated efficacy in improving outcomes, its use is often complicated by complex inclusion and exclusion criteria, risk of hemorrhage, requirement for intense patient monitoring, substantial cost, and the potential for devastating medication errors.
急性中风是急诊科常见的病症，是美国第三大死因。尽管此类事件频发，且具有较高的发病率和死亡率，但几乎没有什么疗法能够限制这种毁灭性诊断所带来的损害。一种在这种情况下已证明有效的缺血性中风药物疗法是组织纤溶酶原激活剂（爱通立；tPA；阿替普酶）。针对该药物的现行指南建议，符合特定标准的患者应在中风症状发作后的头3小时内使用。然而，最近的数据已促使在特定患者群体中将这个时间范围延长至症状发作后的4.5小时。尽管这种疗法已证明在改善预后方面有效，但其使用往往因复杂的纳入和排除标准、出血风险、需要密切监测患者、成本高昂以及存在严重用药错误的可能性而变得复杂。
