流程改进与智能时间追踪在急性缺血性脑卒中溶栓流程中的作用

目的研究急性缺血性脑卒中流程改进与电子信息智能时间追踪系统对缩短缺血性脑卒中患者从入院到溶栓治疗的时间(door to needle time,DNT)及溶栓率的影响。方法选取我院神经内科收治的2592例急性缺血性脑卒中(acute ischemic stroke,AIS)患者,其中静脉溶栓患者共243例,优化流程前组有106例,优化流程后组有137例。回顾分析开通绿色通道及智能时间追踪前、后两组接受静脉溶栓的AIS患者的临床资料。对两组患者的DNT、DNT≤60分钟的比例,以及时间窗内患者溶栓率及总溶栓率进行分析,比较优化流程并采取智能时间追踪前后上述指标的变化。结果优化流程并利用电子信息系统实时监控后,年龄80岁的患者比例增高(P0.05),DNT显著缩短(P0.01),且时间窗内就诊的AIS患者溶栓率有了明显的提高(P0.01),而总体AIS患者溶栓率虽有提高,但差异无统计学意义(P0.05)。两组患者在症状性出血转化及死亡方面差异无统计学意义(P0.05)。结论启动急性缺血性脑卒中静脉溶栓绿色通道及智能时间追踪系统可显著缩短DNT,提高时间窗内患者溶栓率及总溶栓率,且安全有效。     

如何延长急性缺血性卒中溶栓治疗时间窗?

溶栓治疗目前是急性缺血性卒中最有效的治疗方法,发病3h内静脉给予重组组织型纤溶酶原激活剂是唯一被美国食品和药品监督管理局批准用于急性缺血性卒中治疗的药物.不过,由于静脉溶栓治疗的时间窗很短,只有极少数患者能在发病3h内到达医院并接受静脉溶栓治疗.因此,如何延长溶栓治疗时间窗,使更多的患者有机会接受溶栓治疗并从中获益,是学者们一直关注的问题.文章对近年来有关延长溶栓治疗时间窗的研究进展进行了综述.     

阿替普酶溶栓治疗急性缺血性脑卒中并发腹膜后出血继发自发性脾破裂一例

随着医疗条件不断提高,人口老龄化逐渐加剧,心脑血管疾病逐年上升.临床上常见的急性缺血性脑卒中发病率明显提高.目前,在有效时间窗内进行阿替普酶静脉溶栓治疗急性缺血性脑卒中已广泛应用于临床.溶栓后出血是最常见的药物不良反应,但引发腹膜后出血继发自发性脾破裂出血实属少见,目前国内鲜见相关报道.本研究报道1例阿替普酶溶栓治疗急...     

不同时间窗急性缺血性脑卒中患者及不同药物在静脉溶栓治疗中的临床应用推荐:2021版《欧洲卒中组织急性缺血性脑卒中静脉溶栓指南》解读

2021年2月《欧洲卒中组织(ESO)急性缺血性脑卒中静脉溶栓指南》(以下简称2021版ESO指南)发布,其全面系统地总结了急性缺血性脑卒中静脉溶栓(IVT)治疗的最新研究进展,2021版ESO指南是对2008版《缺血性脑卒中和短暂性脑缺血发作治疗指南》的更新,共48条推荐意见,提供了不同患者亚组、超时间窗、影像学选择...     

急性缺血性卒中血管内治疗——中美指南解读

2013年各国指南明确指出在时间窗内进行静脉溶栓治疗是唯一被证实可以降低缺血性脑卒中致残率的有效方法,但中美2015年中美急性缺血性卒中血管内治疗指南存在一定差异,汇总如下。血管内治疗是否可以替代静脉溶栓？2015年中国指南推荐：机械取栓推荐使用机械取栓治疗发病6 h内的急性前循环大血管闭塞卒中患者,发病4.5 h内者则可在足量静脉溶栓基础上进行（Ⅰ级推荐,A级证据）;     

替罗非班对超溶栓时间窗老年急性缺血性脑卒中患者的疗效分析

目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)超溶栓时间窗老年患者应用替罗非班的有效性及安全性.方法 选取2019年10月～2020年2月郑州市第一人民医院神经内科收治的超溶栓时间窗老年AIS患者150例,随机分为观察组75例和对照组75例,对照组给予常规药物治疗,观察组在常规药物治疗...     

缺血性脑卒中神经保护治疗的临床研究进展

<正>缺血性脑卒中是一类常见威胁人类健康的疾病,有较高致残率及致死率[1]。循证医学证实,治疗缺血性脑卒中有效的手段包括卒中单元、溶栓治疗(包括动静脉溶栓)和抗栓治疗。由于时间窗的限制,仅少数患者能获取溶栓的治疗机会,对于不能接受溶栓治疗的患者,如何最大程度的减少神     

远程缺血后处理对急性缺血性脑卒中缺血再灌注损伤的保护

<正>缺血性脑卒中通常是由于血管狭窄或闭塞引起,在有效时间窗内重新恢复或开通病变血管,实现缺血脑组织的再灌注是缺血性脑卒中急性期治疗的重要措施。目前,急性缺血性脑卒中的治疗,无论是公认和首选的静脉溶栓,还是动脉溶栓、桥接、机械取栓、血管成形、支架术等血管内介入治疗,最终目的均为开通血管,实现缺血脑组织再灌注。但在脑缺     

静脉溶栓患者疗效与预后因素分析

<正>我国脑卒中发病率高,且致残率、病死率高。发病在4.5 h以内的急性缺血性卒中患者,根据各国急性缺血性卒中治疗指南推荐,可应用重组组织型纤溶酶原激活物(rt-PA)进行静脉溶栓治疗。著名的NINDS试验[1]及ECASSIlI试验~[2]均为静脉溶栓提供了循证医学证据。静脉rt-PA溶栓治疗急性超早期脑梗死也是目前国内外使用最广泛的,得到最强推荐的治疗方法~[3,4]。然而,我国在治疗"时间窗"     

优化急性缺血性脑卒中静脉溶栓绿色通道流程

目的 探讨优化急性缺血性脑卒中患者静脉溶栓绿色通道流程的效果.方法 选取我院收治的140例急性缺血性脑卒中患者为研究对象,2018年1月至8月本科室收治的静脉溶栓患者70例为对照组,2019年5月至12月优化急性缺血性脑卒中静脉溶栓绿色通道治疗流程后收治的患者70例为观察组.比较两组患者急诊至抽血检验时间、急诊至CT完...     

急性缺血性卒中的溶栓治疗

急性缺血性卒中的溶栓治疗是目前医学研究的热点。近年来的研究表明,溶栓治疗的时间窗应个体化。新的影像学技术有助于判断缺血半暗带和选择适合溶栓的病例。溶栓治疗的方法包括静脉溶栓、动脉溶栓和动静脉联合溶栓。影响溶栓疗效的因素包括从发病到开始溶栓治疗的时间、患者基础状况、溶栓药和联合用药、入选和治疗标准的执行情况以及是否在卒中单元内监护。     

缺血性卒中患者的血管内治疗模式

目的缺血性脑血管病是成年人群死亡和残疾的主要原因之一。超早期血管再通是迄今最为肯定的治疗方法。相对于静脉溶栓,各种模式的血管内治疗能扩展治疗时间窗和增高血管再通率。此外,介入治疗还能通过提高侧支循环灌注来改善患者的临床转归。文章就既往临床研究中验证的各种血管内治疗模式及其在我国的应用情况进行了综述。     

An Accelerated Hemostasis Protocol following Transradial Cardiac Catheterization Is Safe and May Shorten Hospital Stay: A Single‐Center Experience

Introduction: Hemostasis following transradial cardiac catheterization is achieved by external pressure application using various devices, TR Band? being one. There is no standardized protocol for the application and removal of such devices. Objective: To assess the safety and feasibility of a more rapid (1 hour) initiation of TR Band? removal ([time to wean] TTW1) compared to a recommended 2 hour protocol (TTW2) in a controlled prospective study. Methods: 100 consecutive outpatients undergoing diagnostic transradial cardiac catheterization prospectively underwent an accelerated initiation of post‐procedure TR Band? removal (TTW1 group). The controls were a random historical cohort of 25 patients who had the conventional 2 hours to wean approach (TTW2). Results: The mean age was 62 years with a mean BMI of 29 kg/m²; 51% were hypertensive and 9% were on warfarin anticoagulation. As defined, the median times to TR Band? weaning were 60 minutes and 120 minutes for TTW1 and TTW2 groups, respectively, p < 0.001. TTW1 patients had more oozing leading to insignificant delay in the weaning process (16% vs 4% in the TTW2 group, p = NS). The total time, however, from TR Band? application to removal was significantly shorter in the TTW1 group compared to TTW2 (median of 120 minutes [mean 127] vs 180 minutes [mean 187], p < 0.001). There were no differences in any prespecified complications. Conclusion: A rapid 1‐hour commencement of TR Band? weaning following transradial diagnostic cardiac catheterization appears to be safe. It shortens the overall device removal time and may shorten hospital stay in day‐case procedures.     

Neurotrophin-3 improves functional constipation

OBJECTIVE: Neurotrophin-3 (NT-3) is a neurotrophic factor involved in the growth, development, and function of the nervous system. In preliminary studies, s.c. recombinant methionyl-human NT-3 enhanced transit throughout the GI tract and increased stool frequency in normal and constipated subjects. Our aim was to assess 1) the dose-related effects of NT-3 on bowel function, colon transit, and symptoms of chronic constipation, and 2) its safety. METHODS: This was a double-blind, randomized, placebo-controlled phase II study. A total of 107 patients with a diagnosis of functional constipation (Rome II criteria) were randomized to receive 4 wk of double blind, s.c. injections of either placebo, 3 mg, or 9 mg NT-3 once per week (qW) or three times per week (TTW); or 9 mg NT-3 TTW for 1 wk, then qW. The primary endpoint was the change in number of spontaneous, complete bowel movements per week. Colon transit was assessed before and at end of treatment. RESULTS: Compared with placebo, patients who received 9 mg NT-3 TTW showed significant increases in frequency of spontaneous, complete bowel movements and total bowel movements, as well as dose-related softening of stool and improved ease of passage. The number of days per week without a bowel movement also decreased, colon transit improved, as did constipation-related symptoms. Weekly dosing was ineffective. Transient injection-site reactions, seen in one third of patients receiving NT-3 TTW, were the most frequent adverse event. CONCLUSIONS: NT-3, administered TTW, increased stool frequency, enhanced colon transit, and improved symptoms of chronic constipation. NT-3 seems to be a novel, safe, and effective agent for the treatment of functional constipation.     

Emergency Management of Acute Ischemic Stroke

With the advent of new therapeutic options for acute ischemic stroke, expeditious evaluation of patients with suspected stroke has become imperative. Goals of the initial evaluation are to determine the time of symptom onset, severity of the neurologic deficit, and to exclude intracranial hemorrhage and other mimics of acute ischemic stroke. CT and MRI perfusion studies may demonstrate the presence of an ischemic penumbra and aid in identification of patients who may benefit from thrombolysis. Intravenous recombinant tissue plasminogen activator (IV rtPA) remains the gold standard for acute ischemic stroke treatment, and the therapeutic time window recently has been extended to 4.5 h in certain patients. Catheter-based intra-arterial thrombolysis is being used increasingly as “rescue therapy” after IV rtPA and as primary therapy in select patients who are ineligible for intravenous therapy. Trials investigating the efficacy and safety of intra-arterial therapy are ongoing.     

Stroke Treatment Using Intravenous and Intra-Arterial Tissue Plasminogen Activator

OPINION STATEMENT: Acute ischemic stroke is the most common cause of adult disability in the world and the third most common cause of death. Early restoration of perfusion to ischemic brain has been a highly successful strategy to decrease the disability associated with acute ischemic stroke. For acute stroke, intravenous (IV) tissue plasminogen activator (t-PA) is the only proven acute treatment that results in improved clinical outcomes. IV t-PA is indicated for ischemic stroke when administered within 4.5?h or less of symptom onset. This 4.5-hour treatment window represents a significant expansion from the previous 3-hour treatment window for therapy. Despite a longer time window, patients have the greatest chance for an improved outcome when treatment occurs as soon as possible from the time of symptom onset. The Emergency Department goal for treatment is a door to t-PA administration time of 60?min. In order to facilitate rapid evaluation and treatment, systems of care that streamline treatment should be developed at every institution that cares for acute ischemic stroke patients. For those with contraindications to t-PA and those outside the treatment window, catheter-directed intra-arterial (IA) t-PA administration or mechanical clot extraction is a potential means of restoring brain perfusion. These therapies should not preclude the use of IV t-PA when feasible and are frequently only available at tertiary care centers. Technological advances in IA devices for mechanical clot extraction make this a promising and growing area for advancing stroke therapy but remain under ongoing investigation to establish improved clinical outcomes.     

Determinants of time-to-weaning in a specialized respiratory care unit

BACKGROUND: As the decision-making process in long-term respiratory care units often depends on time-based outcomes, we sought to identify independent predictors of time-to-weaning (TTW) in a hospital-based specialized respiratory care unit. METHODS: Characteristics that were identified in previous studies as predictors of weaning success in ICUs and long-term ventilator units were prospectively collected on 113 consecutive admissions to our unit. TTW analyses were performed with Kaplan-Meier curves, log rank test, and Cox proportional regression. RESULTS: The TTW was shorter in patients with static lung compliance (Cst) of > 20 mL/cm H(2)O, a normal creatinine level (0.6 to 1.4 mg/dL), a rapid shallow breathing index (RSBI) of < or = 105, intact skin, and in those patients from a surgical referral source. We found an interaction between RSBI and Cst (p = 0.02) such that patients with an RSBI of < or = 105, regardless of Cst, had a median TTW of 11 days, those with an RSBI of > 105 and a Cst of > 20 had a median TTW of 31 days, and those with an RSBI of > 105 and a Cst of < or = 20 mL/cm H(2)O had not reached a median TTW by 60 days (p = 0.007 [log rank for linear trend]). In a Cox-proportional hazard model, both this categorization model of RSBI and Cst, and renal function had a significant impact on TTW. CONCLUSIONS: In a multivariate model incorporating the variables reviewed, only the lung parameters (RSBI combined with Cst) and renal function remained independently associated with TTW.     

Hyperacute Management of Ischemic Strokes: JACC Focus Seminar

Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide. Intravenous tissue plasminogen activator has been a cornerstone for treatment of acute ischemic stroke for more than 20 years; however, its use is limited due to a narrow therapeutic window, several contraindications, and low efficacy to recanalize the artery in large vessel occlusion. Recently, the addition of endovascular mechanical thrombectomy of large artery occlusion has revolutionized the stroke treatment for most disabling strokes. The paper reviews updates to the thrombolytic treatment as well as catheter-based treatment, and results from recent trials in the selection of patients in an extended time window using perfusion imaging.     

Akutversorgung des isch?mischen Schlaganfalls

New diagnostic and therapeutic developments have led to an innovative approach to stroke therapy. The slogan “time is brain” emphasizes that stroke is a medical emergency comparable to myocardial infarction. The stroke unit conception is an evidence based therapy for all stroke patients and improves outcome significantly. The monitoring of vitals signs and the management of stroke specific complications are highly effective. Early secondary prophylaxis reduces the risk of recurrence. The effect of CT based thrombolysis within the time window of 4,5 h has been substantiated by current data. Stroke MRI holds the promise for an improved therapy by patient stratification and by opening the time window. Interventional recanalisation, vascular interventions and hemicraniectomy complement the therapeutic options in the acute phase of stroke.     

A new era of antithrombotic therapy in patients with atrial fibrillation

Atrial fibrillation/flutter is the most common cardiac arrhythmia that can potentially result in stroke and death. For many years, aspirin and warfarin have been the cornerstone of stroke prevention among such patients. Although warfarin therapy has been advocated for patients with high likelihood of stroke, it requires close surveillance and monitoring, has a narrow therapeutic window and is quite often affected by medication interactions and diet. Thus, the need for a better and more consistent anticoagulant therapy was necessary and has been under development with various successes for many years. This article will review 3 new antithrombotic medications that may potentially become the mainstay for treatment of patients with atrial fibrillation in the near future.