Xu Zhi-Peng, Li Hong-Hua, Li Ya-Hong, Zhang Yong, Wu Qiang, Lin Lang
Department of Neurology, Wuhan General Hospital of Guangzhou Command, Wuluo Road 627, Hongshan District, Wuhan 430070, People's Republic of China.
Department of Neurology, Wuhan General Hospital of Guangzhou Command, Wuluo Road 627, Hongshan District, Wuhan 430070, People's Republic of China.
J Clin Neurosci. 2014 May;21(5):822-6. doi: 10.1016/j.jocn.2013.08.014. Epub 2013 Oct 19.
The time window for intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment in acute ischemic stroke (AIS) patients has been extended to 4.5 hours. But little is known about the safety and efficacy of IV rt-PA treatment in the 3-4.5 hour time window in Chinese patients with AIS. A total of 119 patients who were treated with standard IV rt-PA therapy within 4.5 hours after symptom onset were included in this study: 85 were treated within 0-3 hours and 34 were treated within 3-4.5 hours. Favorable outcome was defined as a modified Rankin scale (mRS) score of 0-1 at 6 months. The safety of IV rt-PA treatment was assessed by the rate of mortality, symptomatic intracerebral hemorrhage (SICH) and other common complications. There were no significant differences in SICH rates (2.94% versus 2.35%; p=0.85) at 24-36 hours, mortality (5.88% versus 3.53%; p=0.56), other complications (14.71% versus 11.76%; p=0.66), National Institutes of Health Stroke Scale (NIHSS) score improvement at 24 hours (41.18% versus 45.88%; p=0.64) and favorable mRS at 6 months (52.94% versus 54.12%; p=0.91) between the two time window groups. Multivariate analysis showed that advanced age, lower admission NIHSS score and shorter time from symptom onset to treatment were associated with a favorable clinical outcome. This finding showed an additional 29% of patients received IV rt-PA because of the treatment window expansion to 4.5 hours. IV rt-PA was feasible and safe for treating AIS patients in the 3-4.5 hour time window in our Chinese population.
急性缺血性卒中（AIS）患者静脉注射重组组织型纤溶酶原激活剂（rt-PA）治疗的时间窗已延长至4.5小时。但对于中国AIS患者在3至4.5小时时间窗内进行静脉rt-PA治疗的安全性和有效性知之甚少。本研究纳入了119例症状发作后4.5小时内接受标准静脉rt-PA治疗的患者：85例在0至3小时内接受治疗，34例在3至4.5小时内接受治疗。良好结局定义为6个月时改良Rankin量表（mRS）评分为0至1分。通过死亡率、症状性脑出血（SICH）及其他常见并发症发生率评估静脉rt-PA治疗的安全性。两个时间窗组在24至36小时的SICH发生率（2.94%对2.35%；p = 0.85）、死亡率（5.88%对3.53%；p = 0.56）、其他并发症（14.71%对11.76%；p = 0.66）、24小时时美国国立卫生研究院卒中量表（NIHSS）评分改善情况（41.18%对45.88%；p = 0.64）以及6个月时良好的mRS评分（52.94%对54.12%；p = 0.91）方面均无显著差异。多因素分析显示，高龄、入院时较低的NIHSS评分以及症状发作至治疗的时间较短与良好的临床结局相关。这一发现表明，由于治疗时间窗延长至4.5小时，额外29%的患者接受了静脉rt-PA治疗。在我国人群中，静脉rt-PA治疗3至4.5小时时间窗内的AIS患者是可行且安全的。
