Famularo G, Polchi S, Panegrossi A
Department of Emergency Medicine, Ospedale San Camillo, Rome, Italy.
Eur J Emerg Med. 1998 Jun;5(2):249-52.
Thrombolysis has been shown to be an effective treatment for ischaemic stroke. The major obstacles to more widespread use of this therapy are lack of awareness that treatment is possible and the short, less than 3 hours, therapeutic window. Even though the use of this therapy can be burdened by the occurrence of intracerebral haemorrhages, there is tantalizing evidence that thrombolysis is the only approach that has been so far demonstrated to improve the outcome of these patients. Early recognition of the onset of stroke, the immediate transfer to a suitably equipped facility and careful screening of a computed tomographic scan of the head for signs of early infarction are necessary for the safe administration of intravenous thrombolysis. There is mounting evidence that intra-arterial thrombolysis in combination with transluminal angioplasty has even a greater potential than intravenous thrombolysis and, possibly, a lower rate of intracerebral haemorrhages. Despite doubts having been raised about the use of thrombolysis in routine clinical practice, it appears that this therapy is most effective in those patients treated with careful adherence to published guidelines.
溶栓治疗已被证明是缺血性中风的有效治疗方法。这种疗法更广泛应用的主要障碍是缺乏对治疗可能性的认识以及较短的治疗窗（不到3小时）。尽管这种疗法可能会因发生脑出血而受到影响，但有诱人的证据表明，溶栓是迄今为止唯一已被证明能改善这些患者预后的方法。早期识别中风发作、立即转运至配备适当设备的机构以及仔细筛查头部计算机断层扫描以寻找早期梗死迹象，对于安全进行静脉溶栓治疗是必要的。越来越多的证据表明，动脉内溶栓联合腔内血管成形术甚至比静脉溶栓具有更大的潜力，并且可能脑出血发生率更低。尽管对于在常规临床实践中使用溶栓治疗存在疑虑，但似乎这种疗法在那些严格遵循已发表指南进行治疗的患者中最为有效。
