Wahlgren N G, Terent A, Norrving B, Lindqvist M, Svendsen P, Rådberg J, Hårdemark H G
Neurologiska kliniken, Karolinska sjukhuset, Stockholm.
Lakartidningen. 1998 Jul 8;95(28-29):3202-11.
Thrombolysis using tissue plasminogen activator (tPA) is not the leading strategy in the development of pharmacological treatments for acute ischaemic stroke. The prospect of tPA becoming routine treatment in ischaemic stroke raises several issues the magnitude of the treatment load, the requisite neurological and neuroradiological diagnostic qualifications, identification of local reperfusion effects in the brain, and the pre-hospital and hospital management of acute stroke patients. The results of large randomised trials of intravenous tPA treatment are reviewed in the article, and the current state of our knowledge about interventional thrombolysis is reported. Recruitment for the second European intravenous tPA trail, ECASS II, has recently been completed, and the study findings will be available during the latter half of 1988. In the USA, tPA is already recommended treatment for acute ischaemic stroke within three hours after the onset of symptoms. In Europe, the formulation of guidelines awaits the results of ECASS II.
使用组织型纤溶酶原激活剂（tPA）进行溶栓并非急性缺血性中风药物治疗发展的主要策略。tPA成为缺血性中风常规治疗方法的前景引发了几个问题，如治疗负担的规模、必要的神经学和神经放射学诊断资质、脑部局部再灌注效果的识别以及急性中风患者的院前和院内管理。本文回顾了静脉注射tPA治疗的大型随机试验结果，并报告了我们目前关于介入性溶栓的知识状况。第二项欧洲静脉注射tPA试验ECASS II的招募工作最近已经完成，研究结果将于1988年下半年公布。在美国，tPA已被推荐用于症状发作后三小时内的急性缺血性中风治疗。在欧洲，指南的制定有待ECASS II的结果。
