急诊医生决策静脉溶栓治疗缺血性脑卒中的疗效及安全性评价

摘要

目的：评价急诊医生决策使用重组组织型纤溶酶原激活剂( rt-PA）静脉溶栓治疗急性缺血性脑卒中( AIS）的安全性和有效性。方法搜集2013年6月—2015年1月北京大学人民医院急诊医生决策完成的rt-PA静脉溶栓治疗的AIS患者共86例，其中单独由急诊医生决策完成者66例，由神经科医生辅助完成者20例。回顾性分析患者基本情况、静脉溶栓的院内时间分布、神经系统功能预后、死亡及重要脏器出血事件发生率。结果86例患者平均rt-PA的用量为58.2 mg；来诊至给药溶栓的平均时间为95 min，短于中国卒中登记处专业卒中团队的平均时间116 min；急诊医生决策组患者来诊至给药溶栓的平均时间较神经科医生辅助组更短〔分别为(87±37） min 和(110±45） min〕；溶栓后24 h时，神经系统功能获得改善者56例(65.1％）；出院时神经系统功能预后良好者56例(65.1％）；死亡5例(5.8％）；重要脏器出血15例(17.4％）。结论与神经科医师实施的静脉溶栓相比，急诊医生决策使用rt-PA静脉溶栓治疗AIS相对安全有效，重要脏器出血和死亡风险相当，但溶栓治疗开始时间缩短。%Objective To evaluate the safety and efficacy of intravenous rt-PA thrombolysis for patients with acute ischemic stroke ( AIS) by emergency physicians.Methods In this study, we enrolled 86 AIS patients who underwent rt-PA intravenous thrombolysis by emergency doctors from June 2013 to January 2015 in Peking University People′s Hospital, among which 66 patients received thrombolysis undertaken independently by emergency doctors and 20 patients received thrombolysis undertaken with the aid of doctors of neurology department.A retrospective analysis of patient characteristics, the temporal distribution of different treatment stages in hospital, prognosis of nervous system function, mortality and the incidence of bleeding of major organs was made.Results Among the 86 patients, the average dosage of rt-PA for each patient was 58.2mg.The average time of door to needle ( DTN) was 95 min, shorter than 116 minutes recorded in the Chinese National Stroke Registry by stroke unit staff.Average DTN time in the group of thrombolysis by emergency physicians was shorter than the group by doctors of neurology department 〔(87 ±37) min vs.(110 ±45) min〕.24 hour after thrombolysis, neurological functions of 56 patients (65.1%) were improved; 56 patients ( 65.1%) had a good outcome in nervous system function at discharge; 5 patients (5.8%) died, and bleeding of important organs occurred in 15 patients (17.4%).Conclusion Compared with the thrombolysis by doctors of neurology department, rt-PA thrombolysis by emergency physicians has better safety and similar risk for bleeding of important organs and death but reduces DTN time.