台湾医学中心急性缺血性卒中使用重组组织型纤溶酶原激活物的经验

被引:1
作者
黄柏颖
陈俊鸿
杨渊韩
林瑞泰
林峰正
刘景宽
机构
[1] 高雄医学大学附设中和医院神经内科
关键词
脑梗死; 纤溶酶原激活剂;
D O I
暂无
中图分类号
R743.3 [急性脑血管疾病(中风)];
学科分类号
摘要
目的分析重组组织型纤溶酶原激活物(r-tPA)于台湾一医学中心的使用率。方法针对送到医院的卒中患者我们制定了一套超急性期卒中评估流程。于2004年6月到2005年10月这段期间,入组了182例到院时适用超急性卒中评估流程的患者。依据台湾卒中学会在2003年7月所订立的静脉注射r-tPA准则确定是否给予r-tPA治疗。结果在182例到院时适用超急性卒中评估流程的病例中,只有11例患者(6.04%)可以接受静脉注射r-tPA,4例(2.2%)可以接受动脉注射r-tPA。患者排除注射r-tPA的原因通常是多重因素的,而其中最主要的排除因素包括:症状过于轻微或自行缓解的卒中(46.15%),血压过高(35.1 6%),无法在3h内完成整套评估流程或从卒中发生时到再次确认的时间已经超过3h(24.17%),颅内出血(15.93%)。结论在17个月的入组期间,只有11例患者(6.04%)接受静脉注射r-tPA,4例(2.20%)接受动脉注射r-tPA。整体而言,r-tPA使用率过低,而这跟r-tPA应用准则过于严格可能有关。目前台湾卒中学会已制定新版的r-tPA应用准则,期望能使更多的患者从中受益。
引用
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页码:524 / 528
页数:5
相关论文
共 9 条
[1]   Reasons for exclusion from thrombolytic therapy following acute ischemic stroke [J].
Cocho, D ;
Belvís, R ;
Martí-Fàbregas, J ;
Molina-Porcel, L ;
Díaz-Manera, J ;
Aleu, A ;
Pagonabarraga, J ;
García-Bargo, D ;
Mauri, A ;
Martí-Vilalta, JL .
NEUROLOGY, 2005, 64 (04) :719-720
[2]  
Eligibility for Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke: A Population-Based Study[J] . Dawn Kleindorfer,Brett Kissela,Alex Schneider,Daniel Woo,Jane Khoury,Rosemary Miller,Kathleen Alwell,James Gebel,Jerzy Szaflarski,Arthur Pancioli,Edward Jauch,Charles Moomaw,Rakesh Shukla,Joseph P. Broderick.Stroke: Journal of the American Heart Association . 2004 (2)
[3]  
Prehospital Delay After Acute Stroke in Kaohsiung, Taiwan[J] . Ku-Chou Chang,Mei-Chiun Tseng,Teng-Yeow Tan.Stroke: Journal of the American Heart Association . 2004 (3)
[4]   Predictors of good outcome after intravenous tPA for acute ischemic stroke [J].
Demchuk, AM ;
Tanne, D ;
Hill, MD ;
Kasner, SE ;
Hanson, S ;
Grond, M ;
Levine, SR .
NEUROLOGY, 2001, 57 (03) :474-480
[5]   Protocol violations in community-based rTPA stroke treatment are associated with symptomatic intracerebral hemorrhage [J].
Lopez-Yunez, AR ;
Bruno, A ;
Williams, LS ;
Yilmaz, E ;
Zurrú, C ;
Biller, J .
STROKE, 2001, 32 (01) :12-16
[6]  
Initial clinical experience with IV tissue plasminogen activator for acute ischemic stroke: A multicenter survey[J] . D. Tanne,V. E. Bates,P. Verro,S. E. Kasner,J. R. Binder,S. C. Patel,H. H. Mansbach,S. Daley,L. R. Schultz,P. N. Karanjia,P. Scott,J. M. Dayno,K. Vereczkey-Porter,C. Benesch,D. Book,W. M. Coplin,D. Dulli,S. R. Levine.Neurology . 1999 (2)
[7]  
Thrombolytic Therapy for Acute Ischemic Stroke: Why the Majority of Patients Remain Ineligible for Treatment[J] . Robert E O’Connor,Patricia McGraw,Lanny Edelsohn.Annals of Emergency Medicine . 1999 (1)
[8]  
Canadian Guidelines for Intravenous Thrombolytic Treatment in Acute Stroke: A Consensus Statement of The Canadian Stroke Consortium[J] . J.W Norris,A. Buchan,R. Cote,V. Hachinski,S.J. Phillips,A. Shuaib,F. Silver,D. Simard,P. Teal.Canadian Journal of Neurological Sciences / Journ . 1998 (3)
[9]   Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II) [J].
Hacke, W ;
Kaste, M ;
Fieschi, C ;
von Kummer, R ;
Davalos, A ;
Meier, D ;
Larrue, V ;
Bluhmki, E ;
Davis, S ;
Donnan, G ;
Schneider, D ;
Diez-Tejedor, E ;
Trouillas, P .
LANCET, 1998, 352 (9136) :1245-1251