对错误溶栓患者临床转归及安全性的观察

Misdiagnosis of stroke in intravenous rt-PA treated patients:safety and outcomes

目的了解重组组织纤溶酶原激活物(rt-PA)静脉溶栓患者中貌似卒中(SM)患者的发生率、安全性、临床转归及原因。方法对2010年4月—2012年3月发病4.5 h内采用静脉溶栓治疗的急性脑梗死患者资料进行回顾性分析。对其中诊断为貌似卒中的发生率、病因、治疗安全性及临床转归情况进行了统计分析。同时收集了2003—2012年全球公开发表的同类研究文献,对其中的数据进行了合并分析。结果本组91例静脉溶栓患者中,SM占3例(3.3%),分别由药物中毒、Bell麻痹及癫痫引起。3例患者无溶栓相关并发症出现,临床结局较佳。统计文献中共计4200例静脉溶栓患者,貌似卒中者252例(6.0%)。其中无溶栓相关的颅内出血发生,血管源性水肿仅1例,临床结局较好。引起SM的主要原因分别为:癫痫(31.7%,80/252)、转换障碍(24.2%,61/252)、偏头痛(21.0%,53/252)。结论在急性脑梗死静脉溶栓患者中,SM的发生率较低,且rt-PA相关的不良反应少、临床转归较佳。

Objective To determine the incidence,causes,safety and the outcome of patients with stroke mimic （SM） who received i.v recombinant tissue plasminogen activator（rt-PA）.Methods A retrospective analysis was conducted of 91 consecutive patients in the hospital over 2 years period whom were treated withⅣrt-P ／（IVT） within 4.5 h after stroke symptom on set.The frequency,clinical characteristics,safety,and outcome of stroke mimic patients were determined.All available previously published studies in which the incidence,causes,safety and the clinical outcome of IVT in SMs being investigated were also evaluated together.Results Three of 91 patients（3.3%） had final diagnose of SM which include Todd＇s paralysis,isolated cranial nerve palsy and drug intoxication.These stroke mimic patients had no intracranial hemorrhage and had more excellent functional outcomes than patients with ＂real＂ acule ischemic stroke（AIS） after IVT.A pooled analysis of previously published data showed that 252 SMs（6.0%） were found in 4200 AIS patients with IVT and only one angioedema was observed.Not any intracerebral hemorrhage had occurred in these SMs.Patients with SM had a good safety profile and outcomes when treated with rt PA..Seizures（31.1%,80/252）,conversion disorder（24.2%,60/252） and migraine（21.0%, 53/252） were the 3 most common final diagnoses in SMs.Conclusion SMs were infrequent among AIS patients with IVT, and their treatment had favorable safety and outcomes.