Thapa Lekhjung, Shrestha Shikher, Shrestha Pratyush, Bhattarai Suman, Gongal D N, Devkota U P
Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.
J Neurosci Rural Pract. 2016 Jan-Mar;7(1):55-60. doi: 10.4103/0976-3147.172161.
Stroke is the major cause of morbidity and mortality worldwide. The number of stroke patients receiving recombinant tissue plasminogen activator (rt-PA), also known as Alteplase, in the developing world is extremely low. We aim to study the feasibility and efficacy of thrombolysis for the 1(st) time in our country.
In this retrospective study (July 2012-August 2015), acute ischemic stroke patients who were thrombolyzed within 3 h of stroke onset were included. Their demographic profiles, clinical profiles, risk factors, type of thrombolytic used, and outcomes were systematically recorded and analyzed.
A total of 9 patients were thrombolyzed. The mean time from the onset of stroke symptoms to first dose of rt-PA (onset to treatment) was 1.2 h. Six patients had good neurological outcome as measured by modified Rankin Scale (mRS). The median mRS at discharge was 3. Thrombolysis-related post treatment complication was noted in 44.4%, of which nonfatal intracranial bleed occurred only in 2 patients (22.2%). None of the patients receiving intravenous tenecteplase had thrombolysis-related complications, and none of the patients had fatal intracranial bleed.
This study clearly demonstrates the beginning of a feasible and effective thrombolysis in the treatment of acute ischemic stroke in Nepal.
中风是全球发病和死亡的主要原因。在发展中国家，接受重组组织型纤溶酶原激活剂（rt-PA，又称阿替普酶）治疗的中风患者数量极低。我们旨在首次研究我国溶栓治疗的可行性和疗效。
在这项回顾性研究（2012年7月至2015年8月）中，纳入了在中风发作3小时内接受溶栓治疗的急性缺血性中风患者。系统记录并分析了他们的人口统计学特征、临床特征、危险因素、所用溶栓药物类型及治疗结果。
共有9例患者接受了溶栓治疗。从中风症状发作到首次使用rt-PA（发作至治疗）的平均时间为1.2小时。根据改良Rankin量表（mRS）评估，6例患者神经功能恢复良好。出院时mRS中位数为3。溶栓治疗后出现的并发症发生率为44.4%，其中仅2例患者（22.2%）发生非致命性颅内出血。接受静脉注射替奈普酶的患者均未出现与溶栓相关的并发症，也没有患者发生致命性颅内出血。
本研究清楚地表明，在尼泊尔，急性缺血性中风的溶栓治疗已开始具备可行性和有效性。
