Cencer Samantha, Tubergen Tricia, Packard Laurel, Gritters Danielle, LaCroix Hattie, Frye Angela, Wills Nicole, Zachariah Joseph, Wees Nabil, Khan Nadeem, Min Jiangyong, Dejesus Michelle, Combs Jordan, Khan Muhib
Division of Neurology, Neuroscience Institute, Spectrum Health, Grand Rapids, MI, USA.
Michigan State University, Michigan, MI, USA.
Neurohospitalist. 2022 Jul;12(3):504-507. doi: 10.1177/19418744211048014. Epub 2022 Feb 23.
The current standard of practice for patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator (tPA) requires critical monitoring for 24-hours post-treatment due to the risk of symptomatic intracranial hemorrhage (sICH). This is a costly and resource intensive practice. In this study, we evaluated the safety and efficacy of this standard 24-hour ICU monitoring period compared with a shorter 12-hour ICU monitoring period for minor stroke patients (NIHSS 0-5) treated with tPA only. Stroke mimics and those who underwent thrombectomy were excluded. The primary outcome was length of hospital stay. Secondary outcome measures included sICH, deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, favorable discharge to home or acute rehabilitation, readmission within 30 days, and favorable functional outcome defined as modified Rankin scale (mRS) of 0-2 at 90 days. Of the 122 patients identified, 77 were in the 24-hour protocol and 45 were in 12-hour protocol. There was significant difference in length of hospital stay for the 24-hour ICU protocol (2.8 days) compared with the 12-hour ICU protocol (1.8 days) ( < 0.001). Although not statistically significant, the 12-hour group had favorable rates of sICH, 30-day readmission rates, favorable discharge disposition and favorable functional outcome. Rates of DVT, PE and aspiration pneumonia were identical between the groups. Compared with 24-hour ICU monitoring, 12-hour ICU monitoring after thrombolysis for minor acute ischemic stroke was not associated with any increase in adverse outcomes. A randomized trial is needed to verify these findings.
对于接受静脉注射组织型纤溶酶原激活剂（tPA）治疗的急性缺血性中风患者，当前的标准治疗方案要求在治疗后24小时进行严密监测，因为存在症状性颅内出血（sICH）的风险。这是一种成本高昂且资源密集的做法。在本研究中，我们评估了这种标准的24小时重症监护病房（ICU）监测期与较短的12小时ICU监测期相比的安全性和有效性，后者针对仅接受tPA治疗的轻度中风患者（美国国立卫生研究院卒中量表[NIHSS]评分为0 - 5）。排除了疑似中风患者和接受血栓切除术的患者。主要结局是住院时间。次要结局指标包括sICH、深静脉血栓形成（DVT）、肺栓塞（PE）、肺炎、顺利出院回家或接受急性康复治疗、30天内再次入院，以及定义为90天时改良Rankin量表（mRS）评分为0 - 2的良好功能结局。在确定的122例患者中，77例采用24小时方案，45例采用12小时方案。24小时ICU方案的住院时间（2.8天）与12小时ICU方案（1.8天）相比存在显著差异（<0.001）。虽然无统计学意义，但12小时组的sICH发生率、30天再次入院率、顺利出院情况和良好功能结局率均较好。两组之间DVT、PE和吸入性肺炎的发生率相同。与24小时ICU监测相比，轻度急性缺血性中风溶栓后12小时ICU监测与不良结局的增加无关。需要进行一项随机试验来验证这些发现。
