Intravenous tissue-type plasminogen activator therapy for ischemic stroke - Houston experience 1996 to 2000
Intravenous tissue-type plasminogen activator therapy for ischemic stroke - Houston experience 1996 to 2000
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DOI：
10.1001/archneur.58.12.2009
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发表时间：
2001-12-01
影响因子：
--
通讯作者：
Alexandrov, AV
中科院分区：
文献类型：
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作者：
Grotta, JC;Burgin, WS;Alexandrov, AV
背景：根据国家神经疾病和中风研究所的标准，静脉组织型纤溶酶原激活剂 (tPA) 治疗在全国范围内只有不到 5% 的缺血性中风患者接受，但安全性参差不齐。我们中心在用静脉 tPA 治疗大量中风患者方面拥有丰富的经验。目的：报告我们在连续治疗缺血性中风患者方面的 4 年经验。设计：对我们中风团队见过的所有患者进行前瞻性队列登记，并对 1996 年 1 月 1 日至 2000 年 6 月 1 日期间治疗的所有患者进行额外的回顾性医疗记录审查。 中风专科人员为大城市的 1 所大学和 3 所社区医院提供服务。患者：在症状出现的前 3 小时内连续接受治疗的缺血性中风患者。干预：根据国家神经疾病和中风研究所的方案，静脉注射 0.9 毫克/公斤的组织型纤溶酶原激活剂。主要结果指标：数量和比例 结果：1996年1月1日至2000年6月1日期间共有269名患者接受治疗。他们的平均年龄为68岁（年龄范围为24-93岁）； 48% 是女性。这占我们最活跃医院入院的所有患有脑缺血症状的患者的 9%（在过去 6 个月中，占所有出现脑缺血症状的患者的 13%，占所有急性缺血性中风患者的 15%）。治疗前，美国国立卫生研究院卒中量表 (NIHSS) 的平均 SD 评分为 14.4 +/- 6.1 分（中位数为 14 分；范围为 4-33 分）。第 137 分钟（范围：30-180 分钟）给予 tPA 推注； 28%的患者在2小时内得到治疗。平均进针时间为70分钟（范围为10-129分钟），第二组脑部扫描患者中症状性脑出血发生率为5.6%（占所有患者的4.5%），从1996年到2000年呈下降趋势。所有患者中发现违反方案的比例为13%；这些患者的症状性脑出血发生率为15%。 24 小时时，NIHSS 评分为 10 +/- 8 分（中位数为 8 分；范围为 0-36 分）。院内死亡率为 15%，患者出院 NIHSS 评分为 7 +/- 7 分（中位数为 3 分；范围为 0-35 分）。结论：静脉 tPA 治疗可用于高达 15% 的急性缺血性卒中患者，症状性脑出血风险较低。静脉 tPA 治疗的成功经验取决于治疗团队的经验和组织以及对已发布指南的遵守。
Context: Intravenous tissue-type plasminogen activator (tPA) therapy using the National Institute of Neurological Disorders and Stroke criteria has been given with variable safety to less than 5% of the patients who have ischemic strokes nationwide. Our center is experienced in treating large numbers of stroke patients with intravenous tPA.Objective: To report our total 4-year experience in the treatment of consecutive patients who had an ischemic stroke.Design: Prospective inception cohort registry of all patients seen by our stroke team and an additional retrospective medical record review of all patients treated between January 1, 1996, and June 1, 2000.Setting: A veteran stroke team composed of fellows and stroke-specialty faculty servicing 1 university and 3 community hospitals in a large urban setting.Patients: Consecutive patients with ischemic stroke treated within the first 3 hours of symptom onset.Intervention: According to the National institute of Neurological Disorders and Stroke protocol, 0.9 mg/kg of intravenous tissue-type plasminogen activator was administered.Main Outcome Measures: Number and proportion treated, patient demographics, time to treatment, hemorrhage rates, and clinical outcome.Results: A total of 269 patients were treated between January 1, 1996, and June 1, 2000. Their mean age was 68 years (age range, 24-93 years); 48% were women. This represented 9% of all patients admitted with symptoms of cerebral ischemia at our most active hospital (over the final 6 months, 13% of all patients with symptoms of cerebral ischemia and 15% of all acute ischemic stroke patients). Before treatment the mean SD National Institutes of Health Stroke Scale (NIHSS) score was 14.4 +/- 6.1 points (median, 14 points; range, 4-33 points). A tPA bolus was given at 137 minutes (range, 30-180 minutes); 28% of the patients were treated within 2 hours. The mean door-to-needle time was 70 minutes (range, 10-129 minutes), The symptomatic intracerebral hemorrhage rate was 5.6% of those patients with a second set of brain scans (4.5% of all patients), with a declining trend from 1996 to 2000. Protocol violations were found in 13% of all patients; the symptomatic intracerebral hemorrhage rate in these patients was 15%. At 24 hours, the NIHSS score was 10 +/- 8 points (median, 8 points; range, 0-36 points). In-hospital mortality was 15% and the patients' discharge NIHSS scores were 7 +/- 7 points (median, 3 points; range, 0-35 points).Conclusions: Intravenous tPA therapy can be given to up to 15% of the patients with acute ischemic stroke with a low risk of symptomatic intracerebral hemorrhage. Successful experience with intravenous tPA therapy depends on the experience and organization of the treating team and adherence to published guidelines.