溶栓治疗对卒中的获益在 24 小时内均保持：来自 SITS-EAST 登记研究的结果。

Benefit of thrombolysis for stroke is maintained around the clock: results from the SITS-EAST Registry.

机构信息

Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.

出版信息

Eur J Neurol. 2014;21(1):112-7. doi: 10.1111/ene.12257. Epub 2013 Sep 16.

DOI:10.1111/ene.12257

PMID:24102712

Abstract

BACKGROUND AND PURPOSE

The outcome of thrombolysis for early morning and sleep time strokes may be worse because of uncertainty of stroke onset time or differences in logistics. The aim of the study was to analyze if stroke outcome after intravenous thrombolysis differs depending on time of day when the stroke occurs.

METHODS

The data collected in the Safe Implementation of Treatments in Stroke - Eastern Europe (SITS-EAST) Registry between September 2000 and December 2011 were used. Strokes were categorized as night-time 00:00-07:59, day-time 08:00-15:59 and evening-time 16:00-23:59 and were compared in terms of several outcome measures. All results were adjusted for baseline differences.

RESULTS

A total of 8878 patients were enrolled: 18% had night-time, 54% day-time and 28% evening-time strokes. Onset-to-treatment time in patients with night-time strokes was 10 min longer than in day-time and evening-time strokes (P < 0.001). Symptomatic intracerebral hemorrhage by ECASS II definition occurred in 5.6%, 5.6% and 5.3% (adjusted P = 0.41) of the night-time, day-time and evening-time stroke patients, respectively; by SITS definition it occurred in 2.5%, 1.9% and 1.3% (adjusted P = 0.013) and by NINDS definition in 7.8%, 7.6% and 7.5% (adjusted P = 0.74). Patients with night-time, day-time and evening-time strokes achieved modified Rankin Scale score 0-1 in 33%, 31%, 31% (adjusted P = 0.34) and 0-2 in 52%, 51%, 50% (adjusted P = 0.23), and 13%, 15%, 16% respectively of patients died (adjusted P = 0.17) by 3 months.

CONCLUSIONS

The time when stroke occurs (day versus evening versus night) does not affect the outcome after thrombolysis despite the fact that patients with night-time strokes have worse time management.

摘要

背景与目的

由于对卒中发病时间的不确定性或物流方面的差异，清晨和睡眠时间卒中患者的溶栓治疗结局可能更差。本研究旨在分析卒中发生时间不同是否会影响静脉溶栓治疗后的结局。

方法

使用 2000 年 9 月至 2011 年 12 月期间在 Safe Implementation of Treatments in Stroke-Eastern Europe（SITS-EAST）登记处收集的数据。卒中被分类为夜间（00:00-07:59）、白天（08:00-15:59）和傍晚（16:00-23:59），并比较了几种结局指标。所有结果均按基线差异进行调整。

结果

共纳入 8878 例患者：18%为夜间卒中，54%为白天卒中，28%为傍晚卒中。夜间卒中患者的发病至治疗时间比白天和傍晚卒中患者长 10 分钟（P<0.001）。按 ECASS II 定义，夜间、白天和傍晚卒中患者的症状性颅内出血发生率分别为 5.6%、5.6%和 5.3%（调整后 P=0.41）；按 SITS 定义发生率分别为 2.5%、1.9%和 1.3%（调整后 P=0.013），按 NINDS 定义发生率分别为 7.8%、7.6%和 7.5%（调整后 P=0.74）。夜间、白天和傍晚卒中患者改良 Rankin 量表评分 0-1 的比例分别为 33%、31%和 31%（调整后 P=0.34），0-2 的比例分别为 52%、51%和 50%（调整后 P=0.23），3 个月时死亡率分别为 13%、15%和 16%（调整后 P=0.17）。