提高急性缺血性卒中静脉溶栓有效性和安全性的研究进展

重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator alteplase,rt-PA)是目前急性缺血性卒中时间窗内静脉溶栓最有效的治疗药物,然而,静脉溶栓也伴随着出血转化、症状性颅内出血风险的增加,导致患者预后不良,甚至死亡。因此,研究静脉溶栓治疗及预后的影响因素,提高静脉溶栓治疗的有效性及安全性,对急性缺血性卒中患者的预后有着重大意义。     

前-后循环急性脑梗死静脉溶栓疗效比较及安全评价

目的探讨前-后循环急性脑梗死静脉溶栓疗效差异及安全性评价。方法对前-后循环急性脑梗死120例,其中前循环64例及后循环56例急性脑梗死进行rt-PA静脉溶栓治疗,比较两组间神经功能恢复情况;并通过Logistic回归分析影响急性脑梗死rt-PA静脉溶栓后出血风险的独立危险因素。结果两组患者经溶栓治疗后24h、2w神经功能较溶栓治疗前均有明显恢复(P<0.01),两组之间溶栓治疗后24h神经功能恢复差异无统计学意义,但两组之间溶栓治疗后2w神经功能恢复差异有统计学意义(P<0.05);Logistic回归分析表明高血压病、心房纤颤、糖尿病及吸烟增加rt-PA静脉溶栓出血风险。结论在急性脑梗死的rt-PA静脉溶栓治疗中,前循环疗效优于后循环,且高血压病、心房纤颤、糖尿病及吸烟影响rt-PA静脉溶栓疗效,有增加出血风险可能,从而影响患者日后生活质量。     

急性脑梗死超早期重组组织型纤溶酶原激活物溶栓治疗的临床研究

目的:探讨发病6h内急性脑梗死给予重组组织型纤溶酶原激活物(rt-PA)溶栓治疗的疗效及并发症,并分析预后相关因素。方法:共收集本院2001-2005年70例溶栓治疗的急性脑梗死病例,其中52例静脉溶栓,18例动脉溶栓,分析比较两组病例溶栓前后及3个月随访的ESS评分及Barthel指数结果;同时分析与预后相关的因素。结果:静脉和动脉溶栓组溶栓前及溶栓30min后ESS评分及Barthel指数迅速增加,溶栓前后分值有显著差异。1个月内颅内出血率为5.77%(静脉组)和16.67%(动脉组)。3个月时ESS评分及Barthel指数较溶栓后30min的评分有显著改善。结论:6h内动脉、静脉溶栓治疗均安全有效。     

急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓前后的血液动力学改变

目的 观察急性脑梗死患者重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator,rt-PA）超早期静脉溶栓治疗后脑血液动力学变化及临床转归。方法 2002年9月至2006年4月发病3h以内的急性脑梗死患者,符合美国国家神经疾病和卒中研究National Institute of Neurological Disorders and Stroke,NINDS）溶栓入选标准,用rt-PA 0.9 mg/kg（最大剂量不超过90 mg）溶栓治疗。同时用经颅多普勒超声（TCD）于患者溶栓前、溶栓中、溶栓后24 h、3 d、2周和1个月分别监测其病变血管血液动力学变化。结果 18例患者进行了脑血液动力学监测。男15例、女3例,平均年龄（65±9）岁。溶栓前美国国立卫生院卒中量表（National Institures of Health Stroke Scale,NIHSS）评分6～16分,平均（11.4±2.8）分。溶栓前TCD检查TIBI 0级1例,1级3例,2级8例,3级3例,4级2例（大脑中动脉严重狭窄）,5级1例（腔隙性脑梗死）。从发病至开始溶栓的时间2～3 h,平均（2.80±0.20）h。闭塞动脉在溶栓过程中再通2例,溶栓后1 h内再通1例,24 h内再通4例,溶栓再通4 h后再闭塞1例,其余无变化。溶栓前与溶栓后24 h、3 d、2周、1个月的NIHSS评分及TIBI分级均有统计学差异,NIHSS评分与TIBI存在明显的负相关关系。结论 溶栓前后脑血液动力学改变与神经功能变化明显相关,脑血液动力学监测有助于深入了解卒中的发病机制和溶栓疗效。     

颈内动脉系统超急性期脑梗死不同时间窗动、静脉溶栓的对比分析

目的 关注颈内动脉系统超急性期脑梗死的溶栓治疗,探讨起病3～6 h动脉溶栓与3 h内静脉溶栓的疗效差异并比较其安全性.方法 选择发病6 h内的颈内动脉系统超急性脑梗死患者66例,其中38例起病3 h内的患者予静脉溶栓治疗(采用重组组织型纤溶酶原激活剂(rt-PA)0.9 mg/kg静脉溶栓),28例起病3～6 h的患者予动脉溶栓治疗(经股动脉穿刺,经微导管对梗死部位接触性给予rt-PA,总量为0.6 mg/kg).对两组患者治疗前和治疗后2 h、24 h、7 d的神经功能缺损程度评分(NIHSS)以及治疗前和治疗后7 d、90 d的Barthel指数(BI)进行比较,并记录两组的不良事件.结果两组治疗后2 h、24 h、7 d的NIHSS评分与治疗后7 d、90 d的BI评分均较治疗前有明显改善,差异有统计学意义(P<0.05);各时间点NIHSS评分与BI评分在动脉溶栓组与静脉溶栓组之间比较差异无统计学意义(P>0.05);两组不良事件发生率相当.结论 对于颈内动脉系统超急性期脑梗死,3 h内予静脉溶栓具有与3～6 h动脉溶栓相当的疗效,且未增加出血、死亡等不良事件的发生率.在具备介入治疗条件的单位,针对3～6 h起病的合并大动脉病变的急性脑梗死患者,动脉溶栓治疗可能是理想的治疗策略.     

The hemodynamic status within 24?h after intravenous thrombolysis predicts infarct growth in acute ischemic stroke

A rapid and complete recanalization of the occluded artery is the ideal goal when intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is administrated to patients with acute ischemic stroke, i.e., limiting the ongoing ischemia to achieve a better outcome. We explored the effect of complete versus partial recanalization of the occluded intracranial artery after IV thrombolysis on the infarct growth and evaluated the functional impact. Using diffusion-weighted (DWI) volumetric measurements before rt-PA administration (DWI(1)) and 24?h later (DWI(2)), we calculated the infarct growth in 36 consecutive patients with ischemic stroke treated with IV rt-PA, with the formula DWI(2)/DWI(1). Recanalization of the affected artery was assessed by transcranial Doppler (TCD) and magnetic resonance angiography (MRA) within 24?h of stroke onset. Three patients were eliminated from the analysis; 33?patients were fully analyzed (men: n?=?23; mean (SD) age: 72.4?±?16?years; time from stroke onset to rt-PA: 179?±?54?min; mean NIHSS score at admission: 17). Patients achieving full recanalization by TCD had a smaller infarct growth, compared to those who had a partial or persistent occlusion after thrombolysis: 1.86 versus 2.91 (P?=?0.017). This difference was not significant using MRA criteria: 2.01 versus 2.69 (P?=?0.193). In the regression analysis, complete recanalization by TCD was an independent predictor of infarct growth (P?=?0.045). Thus, complete recanalization measured by TCD within 24?h of IV thrombolysis was independently associated with smaller infarct growth.     

急性缺血性卒中静脉溶栓治疗的疗效及预后相关因素分析

目的::静脉溶栓治疗是急性缺血性卒中最有效的治疗方法。本研究旨在探讨在现行卒中指南的指导下,静脉溶栓治疗的早期疗效和远期预后,以期为提高静脉溶栓治疗的获益提供临床证据。方法::记录136例接受重组组织型纤溶酶原澈活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗的急性缺血性卒中患者的人口统计学特征、血管危险因素和本次卒中发生的情况。采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)对静脉溶栓治疗的早期疗效进行评价,改良Rankin量表(modified Rankin scale,mRS)对卒中发生后3个月时的功能独立情况进行评价。采用单因素和多因素分析对静脉溶栓治疗的早期疗效和卒中发生后3个月时功能独立的相关影响因素进行分析。结果::静脉溶栓治疗后24 h时,早期有效66例(48.5%);卒中发生后3个月时,64例(47.1%)达功能独立。静脉溶栓治疗后2 h、24 h和7 d的早期疗效与卒中发生后3个月时的功能独立显著相关(P值均0.05)。静脉溶栓治疗前收缩压是静脉溶栓治疗早期疗效的独立影响因素(P0.05)。结论::降低静脉溶栓治疗前收缩压可能改善溶栓治疗的早期疗效。依据溶栓治疗的早期疗效,可能判断溶栓治疗的远期预后。     

Improvement in stroke quality management by an educational programme

Time after symptom onset in ischaemic stroke has to be as short as possible to increase success of treatment. We prospectively analysed latencies from symptom onset until the start of therapy and the rate of thrombolysis in 196 patients with suspected stroke sequentially admitted to the hospital before (6 weeks prior, n = 83) and after (n = 113) initiating an educational stroke programme (EP). A total of 345 dispatchers, paramedics, and emergency staff were trained, each person for at least 2 h. The mean pre-hospital time interval from symptom onset until admission was significantly decreased by nearly 2 h (p < 0.05). Thrombolytic therapy frequencies increased from 2 to 10.5% (p < 0.01) because the overall mean time interval from admission to the start of therapy significantly decreased (p < 0.01) by 69 min after the EP, with increasing numbers of patients suitable for acute stroke therapies within a 0- to 3-hour treatment window.     

Eligibility for recombinant tissue plasminogen activator in acute ischemic stroke: way to endeavor

BACKGROUND: The eligibility for recombinant tissue plasminogen activator (rtPA) is rare. We analyze the reasons for exclusion from rtPA among patients who were admitted to our hospital within 3 h. METHODS: A strict protocol for hyperacute stroke was set in a university teaching hospital. Consecutive patients activating the protocol from June 2004 to October 2005 were prospectively registered and entered into a computerized database. The patients were excluded from rtPA according to the modified exclusion criteria from the National Institute of Neurological Disorders and Stroke rtPA trial. RESULTS: Of the 182 patients activating the protocol, only 11 (6.04%) received intravenous rtPA and 4 (2.2%) IA thrombolysis. Patients were excluded for multiple reasons, and the main reasons for exclusion were minor or improving stroke (46.15%), hypertension (35.16%), insufficient time to complete studies or onset beyond 3 h after reconfirmation (24.17%) and intracranial hemorrhage (15.93%). Of 167 excluded patients, 72 (43.11%) were excluded by a single criterion, 53 (31.73%) by 2 criteria and 29 (17.36%) by 3 criteria. The mean time from hospital arrival to presentation to a neurologist was 9.24 +/- 15.11 min (n = 164, median = 8.00, mode = 10, range = 0-65). The mean time from hospital arrival to computed tomography (CT) was 21.67 +/- 23.95 min (n = 167, median = 20.00, mode = 10, range = 4-68). CONCLUSION: An intrahospital stroke code was implemented to minimize intrahospital delay. However, only 11 patients received intravenous rtPA and 4 IA thrombolysis at our hospital from June 2004 to October 2005. The result brings into question the neurologist's conservative interpretation of the criteria and the necessity to clearly define some criteria. Furthermore an intrahospital stroke code should also be implemented for inpatients to maximize the eligibility for rtPA.     

Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI

BACKGROUND AND PURPOSE: Intravenous recombinant tissue plasminogen activator (rtPA) administration is an effective therapy for ischemic stroke when initiated within 3 hours and possibly up to 6 hours after symptom onset. To improve patient selection, a fast diagnostic tool that allows reliable diagnosis of hemorrhage and ischemia, vessel status, and tissue at risk at an early stage may be useful. We studied the feasibility of stroke MRI for the initial evaluation and follow-up monitoring of patients undergoing intravenous thrombolysis. METHODS: Stroke MRI (diffusion- and perfusion-weighted imaging [DWI and PWI, respectively], magnetic resonance angiography, and T2-weighted imaging) was performed before, during, or after thrombolysis and on days 2 and 5. We assessed clinical scores (National Institutes of Health Stroke Scale [NIHSS], Scandinavian Stroke Scale [SSS], Barthel Index, and Rankin scale) at days 1, 2, 5, 30, and 90. Furthermore, we performed volumetric analysis of infarct volumes on days 1, 2, and 5 as shown in PWI, DWI, and T2-weighted imaging. RESULTS: Twenty-four patients received rtPA within a mean time interval after symptom onset of 3.27 hours and stroke MRI of 3.43 hours. Vessel occlusion was present in 20 of 24 patients; 11 vessels recanalized (group 1), and 9 did not (group 2). The baseline PWI lesion volume was significantly larger (P=0.008) than outcome lesion size in group 1, whereas baseline DWI lesion volume was significantly smaller (P=0.008) than final infarct size in group 2. Intergroup outcome differed significantly for all scores at days 30 and 90 (all P<0.01). Intragroup differences were significant in group 1 for change in SSS and NIHSS between day 1 and day 30 (P=0.003) and for SSS only between day 1 and day 90 (P=0.004). CONCLUSIONS: Stroke MRI provides comprehensive prognostically relevant information regarding the brain in hyperacute stroke. Stroke MRI may be used as a single imaging tool in acute stroke to identify and monitor candidates for thrombolysis. It is proposed that stroke MRI is safe, reliable, and cost effective; however, our data do not prove this assumption. Early recanalization achieved by thrombolysis can save tissue at risk if present and may result in significantly smaller infarcts and a significantly better outcome.     

青年卒中患者重组组织型纤溶酶原激活剂静脉溶栓治疗后临床预后不良的危险因素

目的 探讨青年卒中患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后临床预后不良的危险因素.方法 回顾性、连续性纳入胜利油田中心医院2018年1月至2019年12月收治的首次发病并接受rt-PA静脉溶栓的青年卒中患者114例.根据发病90 d mRS评分,将青年卒中患者分为预后良好组(90 d mRS评分0～2分...     

rt-PA联合尿激酶静脉溶栓治疗急性脑梗死的疗效及安全性研究

目的观察重组组织型纤溶酶原激活剂联合尿激酶静脉溶栓治疗急性脑梗死的疗效与安全性。方法选择前循环急性脑梗死患者171例,联合溶栓组46例,单用rt-PA组39例,单用尿激酶组34例,对照组52例。观察治疗前及治疗后14d NIHSS评分,同时观察再梗死率、脑出血率及死亡率。结果 4组治疗后14d分别和治疗前比较,差异有统计学意义(P<0.05);3个溶栓组与对照组14d有效率差异有统计学意义(P<0.05);4组再发脑梗死率、死亡率差异无统计学意义(P>0.05),联合溶栓组脑出血率与单用rt-PA组及单用尿激酶组差异均有统计学意义(P<0.05)。结论 rt-PA联合尿激酶治疗急性脑梗死是安全有效的。     

急性脑梗死患者多模式CT指导下的静脉溶栓治疗

目的 对发病3～9 h内的急性脑梗死患者,应用多模式CT指导下静脉rt-PA溶栓治疗,研究其疗效.方法 2007年8月至2009年5月于我院就诊,经多模式CT筛选出符合溶栓的患者27例.分为＞3～6 h组及7～9 h组,记录溶栓前、后的NIHSS、mRS及BI评分,症状性出血率和病死率.结果 27例样本中20例(74.1%)患者溶栓治疗有效,11例(40.7%)临床结局良好,5例(18.5%)血管完全再通,症状性出血1例(3.7%).其中＞3～6 h组有效率为92.3%(12/13,χ~2=4.34,P=0.037),血管冉通率38.5%(5/13,χ~2=6.608,P=0.010).结论 多模式CT指导下＞3～9 h溶栓是超过常规溶栓时间窗患者的一种可选择的治疗方法.     

Evolution of the Thrombolytic Treatment Window for Acute Ischemic Stroke

Ischemic stroke is a major cause of morbidity and mortality for which the only approved treatment in the acute setting is intravenous thrombolysis. The efficacy and safety of recombinant tissue plasminogen activator (rt-PA) have been firmly established within 3 h of symptom onset; however, few patients are eligible for treatment in this time window. Expanding the time for treatment has been challenging, but new evidence has demonstrated a modest statistical improvement in selected patients when rt-PA is administered within 4.5 h. This important finding hopefully will enable more patients to receive treatment and simultaneously provides an opportunity to reaffirm that the benefits of rt-PA diminish with time.     

缺血性卒中患者静脉rt-PA溶栓治疗的性别差异及其相关因素分析

目的 探讨急性缺血性卒中患者重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator, rt-PA）静脉溶栓治疗性别反应性差异及其可能影响因素。 方法 搜集2012至2013年江苏省临床卒中中心包括南京、徐州和扬州地区,6家三级医院神经内科住 院的急性缺血性卒中发病6 h内,行rt-PA静脉溶栓病例,回顾性分析其不同性别之间的基线危险因素, 溶栓后颅内出血、卒中并发症发生率、神经功能及预后的差异,并分析不同性别患者溶栓后10～14 d 对神经功能产生重要影响的可能相关因素。 结果 本研究共入组289例患者,其中女性111例,男性178例。女性组平均发病年龄,女性组年龄 ≥75岁比率,既往有心房颤动、高血压病史,血小板计数、球蛋白、高密度胆固醇、D-二聚体方面等凝 血水平,溶栓前平均收缩压水平,心源性栓塞性卒中发生率等高于男性组;在既往吸烟、饮酒史,大 动脉粥样硬化性卒中发生率,颅内外磁共振血管造影或计算机断层扫描血管造影术提示的血管内 轻度狭窄率低于男性组;而两组在既往脑血管事件、糖尿病病史,血管内无狭窄率、中度及重度狭窄 率等方面未见明显性别差异。女性在入院时、溶栓后24 h内及10～14 d时神经功能缺损评分、格拉 斯哥昏迷评分、意识受累程度、颅内出血发生率、卒中相关并发症发生率（尤其心血管相关事件发生 率）均高于男性组,24 h内及溶栓后10～14 d神经功能缺损评分下降程度低于男性。而24 h内、溶栓后 10～14 d症状性脑出血及死亡发生率未见显著性别差异。分别对女性组及男性组发病10～14 d神经功 能缺损评分进行线性相关分析,发现入院神经功能缺损评分、早期神经功能改善（24 h内神经功能 缺损评分下降≥8分或24 h神经功能缺损评分为0或1分）、溶栓后10～14 d症状性脑出血发生、既往心 房颤动病史、基线高密度胆固醇水平与女性患者溶栓后10～14 d神经功能相关。同时,入院神经功能 缺损评分、24 h较入院神经功能缺损评分的改善程度,溶栓后10～14 d症状性脑出血发生,发病距离 溶栓时间≤180 mi n发生率与男性患者溶栓后10～14 d神经功能相关。 结论 在本研究中,女性卒中患者溶栓后神经功能获益不如男性,与入院高密度胆固醇水平、入院 神经功能缺损评分、溶栓后24 h内神经功能改善程度、溶栓后症状性脑出血发生、既往有心房颤动病 史等因素相关。     

多模式CT指导下的扩大时间窗溶栓治疗病例分析

目的 探讨在多模式计算机断层扫描（computed tomography,CT）指导下,急性缺血性卒中4.5～9 h重组 组织型纤溶酶原激活剂（recombinant tissue plasminogen activator,rtPA）静脉溶栓的有效性及安全性。 方法 选取在2008至2009年南京大学医学院附属鼓楼医院神经内科临床诊断为急性缺血性卒中且 发病时间在4.5～9 h的6例患者为研究对象,经多模式CT筛选后,进行rtPA（0.9 mg/kg）静脉溶栓治 疗。溶栓前以及溶栓后2 h、24 h和7 d进行美国国立卫生研究院神经功能缺损评分（National Institutes of Heath Stroke Scale,NIHSS）评估神经功能缺损和恢复情况,溶栓后7 d和90 d时行巴氏指数量表 （Barthel Index,BI））评估日常生活能力和改良Rankin量表（modified Rankin Scale,mRS）评估神经功 能,在溶栓后24 h复查多模式CT评估血管再通情况。血管狭窄程度采用缺血性卒中血管栓塞程度量表 （Thrombolysis in Cerebral Ischemia Scale,TICI）分级方法。 结果 在入选的6例患者中,1例患者发生脑出血和病情恶化。6例患者TICI分级评分在溶栓24 h后 较溶栓前显著升高（2.0+0.71 vs 1.0+0.71,P =0.03）。除去1例出血患者,溶栓治疗前后的NIHSS 评分分别为12.2±3.27（溶栓前）和9.4±3.78（溶栓后7 d）,差异具有显著性（P =0.04）。在日常生 活能力方面,与溶栓后7 d相比,BI评分在溶栓后90 d后稍有提高,但差异无显著性（62.5±27.23 vs 47.5±27.84,P =0.13）。患者90 d mRS评分较7 d mRS评分有所好转,但差异无显著性（4±0.82 vs 3±0.82,P =0.09）。 结论 多模式CT指导下扩大静脉溶栓治疗时间窗对促进卒中患者血管再通、神经功能恢复和日常生 活能力提高有促进作用。     

Acute stroke imaging for thrombolytic therapy--an update

More than ten years after its approval intravenous thrombolysis with rtPA still is the only approved therapy for acute ischemic stroke. In this review we aim to give an up-to-date overview of acute stroke imaging within and outside of approved indications for thrombolysis. We discuss the potential applications of modern CT techniques such as CT angiography and perfusion CT as well as stroke MRI for the selection-based treatment of acute ischemic stroke. Recent publications regarding diagnostic strength as well as new randomized trials and larger prospective but open studies are reviewed and discussed. Finally we present a suggestion for the selection of patients for thrombolysis within and beyond the 3-hour time window in the form of an institutional algorithm prioritizing according to present evidence and pathophysiological reasoning.     

重组组织型纤溶酶原激活剂静脉治疗轻型缺血性卒中患者的疗效分析

目的 观察轻型缺血性卒中患者重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator,rt-PA）静脉溶栓治疗的疗效及安全性。      

rt-PA静脉溶栓治疗50例急性脑梗死疗效及安全性分析

目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死的临床效果及安全性。方法选择发病在4.5h内,平均2.86±0.8h内急性脑梗死患者73例,分为两组,溶栓组50例患者给予rt-PA 0.9mg·kg-1·d-1静脉溶栓,常规治疗组23例患者采用抗血小板聚集药物等治疗,比较溶栓和常规治疗后24h、7d及14d美国国立卫生研究院卒中量表(NIHSS)评分并记录不良反应。结果溶栓组治疗后24h、7d及14d时,NIHSS评分较溶栓前及对照组均明显减少,差异有统计学意义(P<0.05);溶栓后头颅MRI/CT及临床表现提示未出现症状性脑出血。结论 rt-PA静脉溶栓治疗发病4.5h内脑梗死是安全有效的。     

中国七城市卒中患者急诊溶栓情况分析

目的 超早期重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator,rt-PA）溶栓治疗是缺血性卒中有效的治疗方法,但目前缺血性卒中救治过程中存在溶栓率偏低的问题,本调查的目的在于了解实际溶栓状况及未溶栓原因。方法 本调查在中国的7个城市31家中心展开前瞻性调查,调查采用标准的登记数据,内容包括患者的一般人口学信息、院前卒中急救信息、院前院内关键延误时间、溶栓信息等。结果 在研究期间,共有1091例患者确诊符合入选标准,其中754例（69.6%）急性缺血性卒中患者中共有20例（2.7%）患者溶栓,其中静脉rt-PA15例、动脉rt-PA2例、静脉尿激酶（Urokinase,UK）3例。在静脉rt-PA中,93.3%（14/15）存在方案违背。大部分病例（17/20）在2 h内就到达了医院,院前延迟平均中位时间为1.17 h。急诊接诊到获得检查（CT或磁共振）平均中位时间为0.67 h。未进行溶栓的主要原因除年龄（>80岁或<18岁）（28.9%）、卒中症状太轻（24.0%）、病情迅速恢复（16.5%）、CT影像已有病灶（15.7%）、时间>3 h（15.7%）、卒中症状太重（7.4%）等因素外,患者/家属主观拒绝仍占了18.2%。结论 急性缺血性卒中溶栓比例偏低,溶栓药物使用不规范且存在方案违背,存在院前延迟问题,亟待整合院前急救中心与医院间医疗资源,规范院前转运途径,缩短延误时间,提高溶栓率。