目的探讨发病4.5~9.0 h的急性缺血性脑卒中(acute ischemic stroke,AIS)患者经多模式CT筛选下超时间窗应用小剂量或标准剂量阿替普酶静脉溶栓的有效性和安全性。方法回顾性分析2021年1月—2023年1月在临沂市中心医院卒中中心就诊的发病...目的探讨发病4.5~9.0 h的急性缺血性脑卒中(acute ischemic stroke,AIS)患者经多模式CT筛选下超时间窗应用小剂量或标准剂量阿替普酶静脉溶栓的有效性和安全性。方法回顾性分析2021年1月—2023年1月在临沂市中心医院卒中中心就诊的发病时间在4.5~9.0 h的104例AIS患者。均完善一站式多模式CT检查,采用F-stroke软件处理分析脑CT灌注成像,存在核心/灌注不匹配者,给予阿替普酶静脉溶栓,并按照采用剂量大小分为小剂量组(0.6 mg/kg体质量,n=53)与标准剂量组(0.9 mg/kg体质量,n=54)。通过对比改良RanKin评分量表(modified RanKin scale,mRS)、美国国立卫生研究院卒中量表(the National Institutes of Health stroke scale,NIHSS)评分评估临床有效性,通过比较出血性转化(hemorrhagic transformation,HT)率、症状性颅内出血(symptomatic intracranial hemorrhage,SICH)率、泌尿道出血率、消化道出血率、病死率评估临床安全性。结果小剂量组预后良好率为58.49%(31/53),标准剂量组预后良好率为59.26%(32/54),差异无统计学意义(P>0.05)。2组溶栓后7 d NIHSS评分低于基线NIHSS评分,溶栓后90 d mRS评分低于入院时mRS评分,差异有统计学意义(P<0.05)。2组溶栓后7 d NIHSS评分、溶栓后90 d mRS评分比较,差异无统计学意义(P>0.05)。小剂量组24 h HT发生率、24 h SICH发生率、泌尿道出血发生率、消化道出血发生率、90 d病死率分别为1.89%(1/53)、1.89%(1/53)、3.77%(2/53)、1.89%(1/53)、1.89%(1/53),标准剂量组分别为9.26%(5/54)、7.41%(4/54)、1.85%(1/54)、5.56%(3/54)、1.85%(1/54),差异无统计学意义(P>0.05)。结论多模式CT筛选指导下发病在4.5~9.0 h的AIS患者超时间窗应用小剂量和标准剂量阿替普酶静脉溶栓有相似的临床疗效,小剂量更安全。展开更多
Background:Intravenous thrombolysis(IVT)is an effective way for treating acute ischemic stroke(AIS).However,its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset fo...Background:Intravenous thrombolysis(IVT)is an effective way for treating acute ischemic stroke(AIS).However,its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for>4.5 h.Methods:We searched PubMed,Embase,Web of Science,Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT(IVT group)and placebo or usual care(control group[CG])in AIS patients with disease onset for>4.5 h.The outcomes of interest included the favorable functional outcome(defined as modified Rankin Scale[mRS]scores 0–1)at 90 days,the functional independence(defined as mRS scores 0–2)at 90 days,proportion of patients with symptomatic intracerebral hemorrhage(sICH)and death at 90 days.We assessed the risk of bias using the Cochrane tool.Pre-specified subgroup analyses were performed by age(70 years or>70 years),National Institute of Health Stroke Scale(NIHSS,10 or>10)and time window(4.5–9.0 h or>9.0 h).Results:Four trials involving 848 patients were eligible.The risk of bias of included trials was low.Patients in the IVT group were more likely to achieve favorable functional outcomes(45.8%vs.36.7%;OR 1.48,95%CI 1.12–1.96)and functional independence(63.8%vs.55.7%;OR 1.43,95%CI 1.08–1.90)at 90 days,but had higher risk of sICH(3.0%vs.0.5%;OR 5.28,95%CI 1.35–20.68)at 90 days than those in the CG.No significant difference in death at 90 days was found between the two groups(7.0%vs.4.1%;OR 1.80;95%CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days,although IVT may induce increased risk of sICH.Care of these patients should well balance the potential benefits and harms of IVT.展开更多
文摘目的探讨发病4.5~9.0 h的急性缺血性脑卒中(acute ischemic stroke,AIS)患者经多模式CT筛选下超时间窗应用小剂量或标准剂量阿替普酶静脉溶栓的有效性和安全性。方法回顾性分析2021年1月—2023年1月在临沂市中心医院卒中中心就诊的发病时间在4.5~9.0 h的104例AIS患者。均完善一站式多模式CT检查,采用F-stroke软件处理分析脑CT灌注成像,存在核心/灌注不匹配者,给予阿替普酶静脉溶栓,并按照采用剂量大小分为小剂量组(0.6 mg/kg体质量,n=53)与标准剂量组(0.9 mg/kg体质量,n=54)。通过对比改良RanKin评分量表(modified RanKin scale,mRS)、美国国立卫生研究院卒中量表(the National Institutes of Health stroke scale,NIHSS)评分评估临床有效性,通过比较出血性转化(hemorrhagic transformation,HT)率、症状性颅内出血(symptomatic intracranial hemorrhage,SICH)率、泌尿道出血率、消化道出血率、病死率评估临床安全性。结果小剂量组预后良好率为58.49%(31/53),标准剂量组预后良好率为59.26%(32/54),差异无统计学意义(P>0.05)。2组溶栓后7 d NIHSS评分低于基线NIHSS评分,溶栓后90 d mRS评分低于入院时mRS评分,差异有统计学意义(P<0.05)。2组溶栓后7 d NIHSS评分、溶栓后90 d mRS评分比较,差异无统计学意义(P>0.05)。小剂量组24 h HT发生率、24 h SICH发生率、泌尿道出血发生率、消化道出血发生率、90 d病死率分别为1.89%(1/53)、1.89%(1/53)、3.77%(2/53)、1.89%(1/53)、1.89%(1/53),标准剂量组分别为9.26%(5/54)、7.41%(4/54)、1.85%(1/54)、5.56%(3/54)、1.85%(1/54),差异无统计学意义(P>0.05)。结论多模式CT筛选指导下发病在4.5~9.0 h的AIS患者超时间窗应用小剂量和标准剂量阿替普酶静脉溶栓有相似的临床疗效,小剂量更安全。
文摘目的探讨优化急诊护理流程对缩短急性缺血性脑卒中患者救治时间应用效果。方法选取2021年3月至8月在北京大兴区中西医结合医院急诊就诊的急性缺血性脑卒中(acute ischemic stroke,AIS)患者110例作为对照组,采用常规护理;同年9月至11月不断优化护理方案;选取2021年12月至2022年10月在大兴区中西医结合医院急诊就诊的AIS患者110例作为治疗组,采用优化后的护理方案。观察比较两组预检分诊——急诊内科医生接诊时间、接诊评估——CT完成时间、预检分诊——溶栓药物首推时间(Door-to-Needle Time,DNT)、静脉溶栓前及溶栓后24小时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分。结果两组年龄、性别、体重、治疗前NIHSS评分等一般资料基线一致具有可比性,治疗组预检分诊——急诊内科医生接诊时间为4.0(3.0,6.0)分钟,低于对照组的6.0(5.0,8.0)分钟;试验组接诊评估——CT完成时间为22.0(16.0,37.0)分钟,低于对照组的36.0(30.0,45.0)分钟;试验组预检分诊——溶栓药物首推时间为33.0(26.5,50.0)分钟,低于对照组58.0(42.0,73.0)分钟。差异均具有统计学意义(P<0.05)。两组溶栓前后组内、组间NIHSS评分比较,差异均无统计学意义(P>0.05)。结论优化急诊护理流程可以缩短预检分诊——溶栓药物首推时间时间,提高预检分诊——溶栓药物首推时间合格率及溶栓治疗率。
文摘Background:Intravenous thrombolysis(IVT)is an effective way for treating acute ischemic stroke(AIS).However,its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for>4.5 h.Methods:We searched PubMed,Embase,Web of Science,Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT(IVT group)and placebo or usual care(control group[CG])in AIS patients with disease onset for>4.5 h.The outcomes of interest included the favorable functional outcome(defined as modified Rankin Scale[mRS]scores 0–1)at 90 days,the functional independence(defined as mRS scores 0–2)at 90 days,proportion of patients with symptomatic intracerebral hemorrhage(sICH)and death at 90 days.We assessed the risk of bias using the Cochrane tool.Pre-specified subgroup analyses were performed by age(70 years or>70 years),National Institute of Health Stroke Scale(NIHSS,10 or>10)and time window(4.5–9.0 h or>9.0 h).Results:Four trials involving 848 patients were eligible.The risk of bias of included trials was low.Patients in the IVT group were more likely to achieve favorable functional outcomes(45.8%vs.36.7%;OR 1.48,95%CI 1.12–1.96)and functional independence(63.8%vs.55.7%;OR 1.43,95%CI 1.08–1.90)at 90 days,but had higher risk of sICH(3.0%vs.0.5%;OR 5.28,95%CI 1.35–20.68)at 90 days than those in the CG.No significant difference in death at 90 days was found between the two groups(7.0%vs.4.1%;OR 1.80;95%CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days,although IVT may induce increased risk of sICH.Care of these patients should well balance the potential benefits and harms of IVT.
