Mehta Anish, Mahale Rohan, Buddaraju Kiran, Majeed Anas, Sharma Suryanarayana, Javali Mahendra, Acharya Purushottam, Srinivasa Rangasetty
Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India.
J Neurosci Rural Pract. 2017 Jan-Mar;8(1):38-43. doi: 10.4103/0976-3147.193558.
Intravenous thrombolysis (IVT) has now become a standard treatment in eligible patients with acute ischemic stroke (AIS) who present within 4.5 h of symptom onset.
To determine the usefulness of IVT and the subset of patients who will benefit from IVT in AIS within 4.5 h.
Patients with AIS within 4.5 h of symptom onset who underwent IVT were studied prospectively. The study period was from October 2011 to October 2015.
A total of 97 patients were thrombolysed intravenously. The mean onset to needle time in all patients was 177.2 ± 62 min (range: 60-360). At 3 months follow-up, favorable outcome was seen in 65 patients (67.1%) and poor outcome including death in the remaining 32 patients (32.9%). Factors predicting favorable outcome was age <65 years ( = 0.02), the National Institute of Health Stroke Scale (NIHSS) <15 ( < 0.001), small vessel occlusion ( = 0.006), cardioembolism ( = 0.006), and random blood sugar (RBS) <250 mg/dl ( < 0.001). Factors predicting poor outcome was diabetes mellitus ( = 0.01), dyslipidemia ( = 0.01), NIHSS at admission >15 ( = 0.03), RBS >250 mg/dl ( = 0.01), Dense cerebral artery sign, age, glucose level on admission, onset-to-treatment time, NIHSS on admission score >5 ( = 0.03), and occlusion of large artery ( = 0.02).
Milder baseline stroke severity, blood glucose <250 mg/dL, younger patients (<65 years), cardioembolic stroke, and small vessel occlusion benefit from recombinant tissue plasminogen activator.
静脉溶栓（IVT）现已成为症状发作4.5小时内符合条件的急性缺血性卒中（AIS）患者的标准治疗方法。
确定IVT的有效性以及在症状发作4.5小时内AIS患者中能从IVT中获益的患者亚组。
对症状发作4.5小时内接受IVT的AIS患者进行前瞻性研究。研究时间为2011年10月至2015年10月。
共有97例患者接受了静脉溶栓治疗。所有患者从症状发作到穿刺的平均时间为177.2±62分钟（范围：60 - 360分钟）。在3个月的随访中，65例患者（67.1%）预后良好，其余32例患者（32.9%）预后不良，包括死亡。预测预后良好的因素为年龄<65岁（P = 0.02）、美国国立卫生研究院卒中量表（NIHSS）评分<15分（P < 0.001）、小血管闭塞（P = 0.006）、心源性栓塞（P = 0.006）以及随机血糖（RBS）<250 mg/dl（P < 0.001）。预测预后不良的因素为糖尿病（P = 0.01）、血脂异常（P = 0.01）、入院时NIHSS评分>15分（P = 0.03）、RBS>250 mg/dl（P = 0.01）、大脑中动脉高密度征、年龄、入院时血糖水平、症状发作至治疗时间、入院时NIHSS评分>5分（P = 0.03）以及大动脉闭塞（P = 0.02）。
基线卒中严重程度较轻、血糖<250 mg/dL、年龄较轻（<65岁）、心源性栓塞性卒中以及小血管闭塞的患者可从重组组织型纤溶酶原激活剂治疗中获益。
