中国急性缺血性脑卒中治疗现状

Treatment of acute ischemic stroke in China

目的按照国家和国际治疗指南，评估中国缺血性脑卒中急性期患者的治疗状况。方法2006年7月1日至11月30日在全国62家医院前瞻性地收集诊断为新发急性脑卒中（脑梗死和脑出血）的所有成人（≥15岁）病例的治疗用药数据。结果筛查了13038例患者，其中符合入组标准的6416例，缺血性脑卒中74．5％（4783例），缺血性脑卒中患者从发病到医院时间平均为20．0h（3．8～59．0h），发病3h内到医院的有1019例（21．3％），溶栓治疗只有1．9％（91／4783例），用神经保护剂和中药治疗的分别为75．9％和83．1％，抗血小板治疗的有80．5％，23．5％的脑卒中患者既未得到溶栓治疗，也未得到阿司匹林治疗。结论目前中国缺血性脑卒中治疗现状喜忧参半：阿司匹林的应用虽然与指南存在差距，但是基本达到西方的应用水平；临床过多使用神经保护剂和中药，而确实有效的溶栓治疗却远远不够，脑卒中发生以后到医院的时间明显长于国外。

Objective To assess the treatment of acute ischemic stroke in China against national and international guidelines. Methods The demographic, clinical and management data were prospectively collected for each consecutive patient with a diagnosis of acute ischemic stroke （ ≥ 15 years old） in 62 hospitals of 32 cities including. Results A total of 13 038 stroke patients were screened over the full 5- month study period. Of these patients, 6622 were excluded because of outside the time window, rapid death, refusal, and that the final diagnosis was not a stroke and others. And 6416 patients were recruited with complete baseline data. Of these patients, there were 4783 patients with ischemic stroke. The mean admission-time was 20 hours （ interquartile range 3. 8-59. 0 hours）. Of them 1019 patients （21.3%） arrived at hospitals within 3 hours of stroke onset. Only 91 （ 1.9% ） patients received thrombolysis. There was high rate of use of traditional Chinese medicines （75.9%） and neuroprotective agents （83.1%）. 80. 5% patients received antiplatelet therapy. 23.5% patients received neither thrombolysis nor aspirin therapy. Conclusions The treatment of acute ischemic stroke in China is not optimal. The use of aspirin is similar with that in Western countries though there are still some differences with the guidelines. Neuroprotective agents and traditional Chinese medicines are overused nevertheless the proportion receiving efficient thrombolysis is much less. The admission-time after stroke onset in China is longer than Western countries. The majority of patients are unable to get benefits from hyperacute stroke diagnosis and therapy, including thrombolysis treatment.