Chiu D, Krieger D, Villar-Cordova C, Kasner S E, Morgenstern L B, Bratina P L, Yatsu F M, Grotta J C
Department of Neurology, University of Texas Houston Health Science Center, USA.
Stroke. 1998 Jan;29(1):18-22. doi: 10.1161/01.str.29.1.18.
The feasibility, safety, and efficacy of intravenous tissue plasminogen activator (t-PA) for patients with acute ischemic stroke in clinical practice need to be assessed.
We initiated a prospective open-label study at a university hospital and two community hospitals in Houston, Tex, immediately after the publication of the National Institute of Neurological Disorders and Stroke (NINDS) t-PA study. A total of 30 patients, age 32 to 90 years, were treated with 0.9 mg/kg of intravenous t-PA (maximum dose, 90 mg) within 3 hours of acute ischemic stroke between December 1995 and December 1996.
Six percent (6%) of all patients hospitalized with ischemic stroke received intravenous t-PA at the university hospital and 1.1% at the community hospitals. The rates of total, symptomatic, and fatal intracerebral hemorrhage were 10%, 7%, and 3%. Thirty-seven percent (37%) of patients recovered to fully independent function. The average time from stroke onset to emergency department arrival was 57 minutes; emergency department arrival to computed tomography scan 41 minutes; and computed tomography scan to administration of treatment 59 minutes.
When treatment guidelines are carefully followed in an urban hospital setting, intravenous t-PA for acute ischemic stroke is feasible and shows safety and efficacy comparable to the results of the NINDS study.
在临床实践中，需要评估静脉注射组织型纤溶酶原激活剂（t-PA）治疗急性缺血性脑卒中患者的可行性、安全性及有效性。
在美国国立神经疾病与卒中研究所（NINDS）t-PA研究发表后，我们于得克萨斯州休斯敦的一家大学医院和两家社区医院开展了一项前瞻性开放标签研究。1995年12月至1996年12月期间，共有30例年龄在32至90岁的患者在急性缺血性脑卒中发病3小时内接受了0.9mg/kg的静脉t-PA治疗（最大剂量90mg）。
在大学医院，6%的缺血性脑卒中住院患者接受了静脉t-PA治疗，在社区医院这一比例为1.1%。总的、有症状的及致命性脑出血发生率分别为10%、7%和3%。37%的患者恢复到完全独立的功能状态。从卒中发作到抵达急诊科的平均时间为57分钟；从抵达急诊科到进行计算机断层扫描的时间为41分钟；从计算机断层扫描到开始治疗的时间为59分钟。
在城市医院环境中，当严格遵循治疗指南时，静脉注射t-PA治疗急性缺血性脑卒中是可行的，其安全性和有效性与NINDS研究结果相当。
