Kurz M W, Kurz K D, Farbu E
Department of Neurology, Stavanger University Hospital, Stavanger, Norway.
Acta Neurol Scand Suppl. 2013(196):57-64. doi: 10.1111/ane.12051.
The understanding of stroke has changed in the recent years from rehabilitation to an emergency approach. We review existing data from symptom recognition to thrombolysis and identify challenges in the different phases of patient treatment.
Implementation of treatment in dedicated stroke units with a multidisciplinary team exclusively treating stroke patients has led to significant reduction of stroke morbidity and mortality. Yet, first the introduction of treatment with intravenous rtPA (IVT) has led to the 'time is brain' concept where stroke is conceived as an emergency. As neuronal death in stroke is time dependent, all effort should be laid on immediate symptom recognition, rapid transport to the nearest hospital with a stroke treatment facility and diagnosis and treatment as soon as possible. The main cause of prehospital delay is that patients do not recognize that they suffered a stroke or out of other reasons do not call the Emergency Medical Services immediately. Educational stroke awareness campaigns may have an impact in increasing the number of patients eligible for rtPA treatment and can decrease the prehospital times if they are directed both to the public and to the medical divisions treating stroke. Stroke transport times can be shortened by the use of helicopter and a stroke mobile--an ambulance equipped with a CT scanner--may be helpful to decrease time from onset to treatment start in the future. Yet, IVT has several limitations such as a narrow time window and a weak effect in ischemic strokes caused by large vessel occlusions. In these cases, interventional procedures and the concept of bridging therapy, a combined approach of IVT and intraarterial thrombolysis or mechanical thrombectomy, might improve recanalization rates and patient outcome.
As neuronal death in stroke patients occurs in a time-dependent fashion, all effort should be made to decrease time from symptom onset to treatment start with rtPA: major challenges are stroke recognition in the public, transport times to hospital and an efficient stroke triage in the hospital.
近年来，对中风的认识已从康复转变为紧急救治方法。我们回顾了从症状识别到溶栓的现有数据，并确定了患者治疗不同阶段的挑战。
在专门的中风单元中由多学科团队专门治疗中风患者，治疗的实施已导致中风发病率和死亡率显著降低。然而，首先静脉注射重组组织型纤溶酶原激活剂（IVT）治疗的引入导致了“时间就是大脑”的概念，即中风被视为一种紧急情况。由于中风中的神经元死亡与时间有关，所有努力都应放在立即识别症状、迅速转运至有中风治疗设施的最近医院并尽快进行诊断和治疗上。院前延误的主要原因是患者未意识到自己中风，或出于其他原因未立即呼叫紧急医疗服务。中风意识教育活动可能会增加符合IVT治疗条件的患者数量，如果针对公众和治疗中风的医疗部门开展，还可以减少院前时间。使用直升机可以缩短中风转运时间，未来配备CT扫描仪的中风移动救护车（一种救护车）可能有助于减少从发病到开始治疗的时间。然而，IVT有几个局限性，如时间窗窄以及对大血管闭塞引起的缺血性中风效果不佳。在这些情况下，介入手术和桥接治疗的概念，即IVT与动脉内溶栓或机械取栓的联合方法，可能会提高再通率和患者预后。
由于中风患者的神经元死亡呈时间依赖性，应尽一切努力减少从症状发作到开始使用rtPA治疗的时间：主要挑战包括公众对中风的识别、到医院的转运时间以及医院内高效的中风分诊。
