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组织类型等离子体激活剂用于急性缺血性中风的使用:克利夫兰地区的经验
I L Katzan1, A J Furlan, L E Lloyd
1Cerebrovascular Center, Cleveland Clinic Foundation, OH 44195, USA. katzani@ccf.org
JAMA
|March 7, 2000
概括
在克利夫兰治疗缺血性中风的静脉组织类型等离子体激活剂 (IV tPA) 后的结果显示,症状性脑内出血 (ICH) 和死亡率很高. 社区使用IV tPA的结果与临床试验不同.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 公共卫生 公共卫生
背景情况:
- 在现实环境中,对急性缺血性中风的静脉组织类型等离子素激活剂 (IV tPA) 治疗的结果尚不清楚.
- 在临床试验之外,关于IV tPA使用及其相关风险的数据有限.
研究的目的:
- 为了评估IV tPA在急性缺血性中风中的利用率.
- 为了确定在接受IVtPA的患者中出现症状性脑内出血 (ICH) 的发生率.
- 评估一个大城市社区的住院患者的结果.
主要方法:
- 从1997年7月到1998年6月进行了一项历史前性队列研究.
- 在克利夫兰,俄俄州大都市区的29家医院收集了3948名因缺血性中风住院的患者的数据.
- 关键的结果措施包括输入式tPA使用,症状性ICH发生,治疗指南偏差和住院死亡率.
主要成果:
- 只有1.8%的缺血性中风患者接受了IV tPA,其中15.7%出现了症状性ICH,包括致命病例.
- 一半接受IVtPA治疗的患者有偏离国家治疗指南的情况.
- 在IVtPA组 (15.7%) 的住院死亡率明显高于未接受tPA (5.1%) 的患者,预计死亡率 (7.9%) 也高于不接受tPA的患者.
结论:
- 克利夫兰的一小部分急性缺血性中风患者接受了IVtPA,经历了高率的症状性ICH.
- 克利夫兰急性缺血性中风的社区IV tPA治疗可能与临床试验结果相比产生不同的结果.
- 需要进一步的研究,以了解和优化IV tPA在不同患者群体中的使用.
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