低劑量靜脈tPA血栓溶解治療在中風病人的效果及安全性

The Efficacy and Safety of Intravenous Low Dose Tissue Plasminogen Activator (tPA) Therapy in Stroke Patients

陳浩榕(Hao-Jung Chen) ； 黃永銓(Yung-Chuan Huang) ； 黃心樂(Shin-Leh Huang) ； 陳媚娟(Mei-Chuan Chen) ； 蘇惠珍(Huei-Chen Su) ； 劉益宏(Yi-Hung Liu) ； 張達人(Ta-Jen Chang) ； 連立明(Li-Ming Lien) ； 陳威宏(Wei-Hung Chen) ； 葉建宏(Jiann-Horng Yeh) ； 邱浩彰(Hou-Chang Chiu) ； 侯勝茂(Sen-Mau Hou)

《台灣醫學》 20卷1期 (2016/01) Pp. 1-7

https://doi.org/10.6320/FJM.2016.20(1).1

摘要

台灣胞漿素原活化劑(tissue plasminogen activator, tPA)血栓溶解治療急性腦梗塞的施打率偏低，尤 其是地區醫院。本研究探討地區醫院成立中風中心，以「低劑量tPA」（0.6毫克/公斤體重，最大劑量60 毫克)治療急性腦梗塞中風的效果及安全性。2013年3月，由醫學中心在地區醫院協助成立中風中心，至 2015年2月的兩年間以經靜脈低劑量tPA治療急性腦梗塞患者。於134位急性腦梗塞患者，33例為中風 發生後3小時内到院，全部可在25分鐘内完成腦部斷層掃描檢查、13例接受低劑量tPA治療 (13/134=9.7%)、11例到院至施打tPA時間＜60分鐘(11/13=84.6%)，無症狀性腦出血發生，與「台灣中風 登錄」相當，8例中風24小時美國國家衛生院腦中風量表(NIHSS)進步＞4分(8/13=61.5%)，8例中風3個 月之改良式Rankin量表(mRS)S1(8/13=61.5%)，也與美國NINDS結果相當。總結：由醫學中心支援，在 地區醫院成立中風中心是可行而省時的；且經靜脈低劑量tPA的效果與標準劑量相當，也可能較安全。

關鍵字

中風中心 ； tPA血栓溶解治療 ； 低劑量tPA ； 急性缺血性腦中風 ； 急性腦梗塞 ； 地區醫院 ； 台灣 ； 中風登錄

並列摘要

The utilization of intravenous tPA-thrombolytic therapy in acute ischemic stroke is low in Taiwan, especially in local community hospitals. This study evaluates the efficacy and safety of low dose tPA therapy (0.6mg/kg����max 60mg) in a stroke center at community hospital. We set up a stroke center in March 2013, and treated patients with acute ischemic stroke with low dose tPA within 3 hours after the onset. Thirty-three (24.6%) out of all 134 infarct patients were sent to hospital within 3 hours after stroke onset and scanned by head CT within 25 minutes. Thirteen patients (9.7%) were treated with tPA. Door to needle time could be kept within 60 minutes in 11 patients (84.6%). There was no symptomatic intracranial hemorrhage. Comparing with the nationwide statistics from Taiwan Stroke Registry, our results are comparable and even better. Eight patients (61.5%) achieved significant improvement in terms of post-tPA reduction of National Institutes of Health Stroke Scale (NIHSS) within 24hrs for more than 4 points. Eight patients (61.5%) had favorable outcome with mRS_1 after 3 months. The results were similar to those from NINDS's study (Standard dose: 0.9mg/kg，max 90mg). Therefore, low dose intravenous tPA therapy was effective and safe in the stroke center at community hospital.

並列關鍵字

stroke center ； tPA thrombolytic therapy ； low dose tPA ； acute ischemic stroke ； acute cerebral infarction ； local community hospital ； Taiwan stroke registry

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