Soto V Álvaro, Morales I Gladys, Grandjean B Marcela, Pollak W Débora, Del Castillo C Carolina, García F Pía, Von Johnn A Alexis, Riquelme G Alfonso
Departamento de Especialidades Médicas, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.
Centro de Investigación en Epidemiología Cardiovascular y Nutricional (EPICYN), Universidad de La Frontera, Temuco, Chile.
Rev Med Chil. 2017 Apr;145(4):468-475. doi: 10.4067/S0034-98872017000400007.
Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activator) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients.
To report the results a thrombolysis protocol during four years in a regional public hospital.
Data from 106 consecutive patients aged 68 ± 13 years (57% men) who were treated with IVT, from May 2012 until April 2016, was analyzed.
The median door-to-needle time was 80 minutes (interquartile range = 57-113). The median National Institute of Health Stroke Scale (NIHSS) scores on admission and at discharge were was 11.5 and 5 points respectively. At discharge, 27% of hospitalized patients had a favorable outcome (n = 99), defined as having 0 to 1 points in the modified Rankin scale. Symptomatic intracerebral hemorrhage and mortality rates were 5.7 and 13.1%, respectively. The thrombolysis rate rose from 0.7% in 2012 to 6% in 2016.
The implementation of 24/7 neurology shifts in the Emergency Department allowed us to increase the amount and quality of IVT in our hospital, as measured by the rate of thrombolysis and by process indicators such as door-to-needle time.
使用阿替普酶（组织纤溶酶原激活剂）进行静脉溶栓是急性缺血性卒中（AIS）的标准药物治疗方法，可降低患者的残疾率。
报告一家地区公立医院四年内溶栓方案的结果。
分析了2012年5月至2016年4月期间连续接受静脉溶栓治疗的106例患者的数据，这些患者年龄为68±13岁（男性占57%）。
从入院到开始溶栓的中位时间为80分钟（四分位间距=57-113）。入院时和出院时美国国立卫生研究院卒中量表（NIHSS）的中位评分分别为11.5分和5分。出院时，27%的住院患者预后良好（n=99），定义为改良Rankin量表评分为0至1分。症状性脑出血和死亡率分别为5.7%和13.1%。溶栓率从2012年的0.7%升至2016年的6%。
急诊科实施全天候神经科值班制度后，我院静脉溶栓的数量和质量均有所提高，这可以通过溶栓率和诸如从入院到开始溶栓的时间等过程指标来衡量。
