中国缺血性卒中早期静脉溶栓的现状、阻碍因素及改进策略

摘要

Intravenous recombinant tissue-type plasminogen activator (rt-PA) is proven to be the most effective method to improve outcomes for acute ischemic stroke (AIS), and the earlier use is companied with the better effects and safeties. However, the low utilization of intravenous rt-PA is a global problem, due to pre-and in-hospital delays. Meanwhile, it has been demonstrated that the thrombolysis rate can be increased and the delays can be shortened after diversity of measurements. After reviewing the advanced correspondent studies in China and developed countries, this article reviews the current state of intravenous thrombolysis for AIS in China, analyzes the barriers to stroke thrombolysis, and puts forwards the improvements in the future, including stroke health education to public and health professional, promoting stroke center certiifcation, and optimizing the pre-and in-hospital processes and the organized administration, etc.%静脉应用重组组织型纤维蛋白酶原激活剂是治疗急性缺血性卒中（acute ischemic stroke, AIS）最有效的方法，且越早治疗获益越多。但全球都存在溶栓率低下，院前、院内延误明显的现象，而针对性干预可以提高溶栓率，缩短从发病至开始溶栓时间。本文结合国内外最新研究结果，对我国AIS的早期静脉溶栓现状进行总结，分析其阻碍因素，并提出我国相应的改进策略。这些措施主要包括加强针对公众和相关行业人员的卒中健康教育，实施卒中中心认证，对院前、院内各环节实施组织化和优化管理等。