急诊启动急性缺血性脑卒中静脉内溶栓治疗对开始溶栓平均时间的影响及其安全性探讨

目的探索急性缺血性脑卒中(AIS)患者在神经内科急诊接受静脉内溶栓和传统收住至病房或卒中单元后接受静脉内溶栓对开始溶栓平均时间(DTN)的影响及其安全性。方法对2012年4月至2015年6月收治的176例AIS患者进行回顾性病例对照分析,比较急诊室启动溶栓组(94例)和病房启动溶栓组(82例)的DTN时间和安全性等指标,包括两组的治疗7 d时和治疗后3个月的病死率、溶栓后24 h症状性出血转化率等。结果两组基线特征差异无统计学意义(P0.05)。急诊溶栓组DTN时间(99.3±47.8)min显著短于病房溶栓组(118.8±53.2)min,P=0.014;治疗后24 h两组安全性比较,症状性颅内出血转化率差异无统计学意义(P0.05),治疗后7 d和3个月两组病死率差异无统计学意义(P0.05);两组溶栓治疗后7 d用美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分(m RS)和溶栓治疗3个月恢复良好(m RS2分)的比例差异无统计学意义(P0.05)。结论在急诊启动静脉内溶栓治疗AIS能明显缩短DTN,安全性与送入病房后再进行静脉内溶栓治疗差异无显著性,AIS的静脉内溶栓治疗应在急诊尽快启动,若急诊空间有限,溶栓和送入病房可同时进行(Drip-and-Ship)。

Start Intravenous Thrombolysis in Emergency Room：Door-to-needle Time and Safety of Acute Ischemic Stroke

Aim To compare the difference of efficacy and safety between receiving intravenous thrombolysis in neurology ward or stroke unit and starting immediately in emergency.MethodsPatients with acute ischemic stroke treated in our department from April 2012 to June 2015 were retrospectively reviewed. Totally, 176 ischemic stroke patients within 4.5 hours received 0.9 mg of alteplase per kilogram of body weight. They were divided into two groups according to the place they started intravenous thrombolysis. DTN time, incidence of symptomatic hemorrhagic transformation 24 hours after intravenous thrombolysis and mortality rate at 7-day and at 3-month were compared.ResultsThere was no signiifcant difference in baseline characteristics. DTN time of the emergency group was significantly shorter than the neurology ward group (99.3±47.8vs 118.8±53.2,P=0.014). Meanwhile, no signiifcant difference was found in the rate of 24-hour symptomatic hemorrhagic transformation, 7-day or 3-month mortality rate, 7-day scores of National Institute of Health Stroke Scale (NIHSS) and the modiifed Rankin Scale (mRS), and 3-month good recovery rate (mRS<2).ConclusionIntravenous thrombolysis in emergency room was safe and could save DTN time. Our observation strongly suggested immediate start of intravenous thrombolysis in neurology emergency. Further reduction of DTN might lead to better efifcacy of intravenous thrombolysis.