Khorvash Fariborz, Heidary Fatemeh, Saadatnia Mohammad, Chitsaz Ahmad, Tolou-Ghamari Zahra
Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.
Isfahan Neuroscience Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2017 Feb 16;22:19. doi: 10.4103/1735-1995.200318. eCollection 2017.
According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV-tPA) necessitates precise documentation of symptoms' onset. The aim of this study was to identify major barriers related to the IV-tPA injection in such patients.
Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction ( = 180) who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV-tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration-approved indications or contraindications.
The mean age of males versus females was 60 versus 77.5 years (ranged 23-93 . 29-70 years), respectively. Out of total population, only 10.7% transferred to hospital in <4.5 h after the onset of symptoms. Regarding to eligibility for IV-tPA, 68.9% of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in <4.5 h after the onset of symptoms and eligibility for IV-tPA, only 6.6% of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75% of population studied. There was a mean of 195.92 ± 6.65 min (182.8-209.04 min) for door to IV-tPA needle time.
Despite the international guidelines for IV-tPA injection within 3-4.5 h of ischemic stroke symptoms' onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms' onset by consultant neurologist in Isfahan/Iran seem to be advantageous.
根据以往的文献报道，在急性缺血性脑梗死患者中，使用静脉注射组织纤溶酶原激活剂（IV-tPA）进行溶栓治疗需要精确记录症状发作时间。本研究的目的是确定此类患者中与IV-tPA注射相关的主要障碍。
在2014年至2015年期间，对就诊于伊斯法罕阿尔扎赫拉医院神经内科病房的确诊为急性脑梗死的患者（n = 180）进行了研究。为了调查与从症状发作到IV-tPA注射时间、个人原因以及患者纳入或排除标准相关的障碍，根据美国食品药品监督管理局批准的适应症或禁忌症设计了三种问卷形式。
男性和女性的平均年龄分别为60岁和77.5岁（范围分别为23 - 93岁和29 - 70岁）。在总人口中，只有10.7%的患者在症状发作后<4.5小时内被送往医院。关于IV-tPA治疗的 eligibility，总人口的68.9%符合此类治疗标准。对于症状发作后<4.5小时内被送往医院和IV-tPA治疗 eligibility这两项，总人口中只有6.6%符合此类管理标准。在75%的研究人群中存在对症状的忽视或不关注。从症状发作到IV-tPA注射的平均时间为195.92 ± 6.65分钟（182.8 - 209.04分钟）。
尽管国际指南建议在缺血性中风症状发作后3 - 4.5小时内进行IV-tPA注射，但本研究结果显示，由于对症状的忽视、文化程度以及独居等原因导致的延误时间可能需要进一步关注。因此，为了降低死亡和残疾率，伊朗伊斯法罕的神经科顾问医生开展的与症状发作相关的教育项目似乎是有益的。
