影響缺血性中風病人到院後至靜脈注射血栓溶解劑時間之因素分析

Factors Affecting the Door-To-Needle Time for Intravenous tPA in Acute Ischemic Stroke

葉旭霖(Hsu-Ling Yeh) ； 侯勝文(Sheng-Wen Hou) ； 王宗倫(Tzong-Luen Wang) ； 林素美(Su-Mei Lin) ； 葉建宏(Jiann-Horng Yeh) ； 陳威宏(Wei-Hung Chen) ； 楊翠華(Tsui-Hua Yang) ； 邱浩彰(Hou-Chang Chiu) ； 連立明(Li-Ming Lien)

《台灣醫學》 20卷2期 (2016/03) Pp. 117-123

https://doi.org/10.6320/FJM.2016.20(2).1

摘要

使用tPA治療缺血性中風的效果會隨著到院至給藥時間(door to needle time, DNT)的延長而減低，本研究的目的在檢討有哪些原因會造成DNT大於60分鐘。分析2012及2013年的急性腦梗塞中風病人資料，將完成急性中風實驗室檢查及電腦斷層所需的時間定義為「完成所有檢驗所需時間」，分析「完成所有檢驗所需時間」與DNT＞60分鐘是否相關，並分析DNT超過60分鐘的因素。結果：「完成所有檢驗所需時間」與DNT是否超過60分鐘沒有顯著相關；DNT超過60分鐘的因素，檢驗時間過長占23.8%，家屬因素占14.3%，病情因素占42.3%，行政因素占4.8%，無明顯原因占14.3%。結論：除了繼續努力縮短檢驗時間，我們應在等待檢驗結果的同時請家屬考慮適合時是否施打，儘早量體重、領藥、控制血壓，並考慮降低或取消臨床疾病嚴重度National Institutes of Health Stroke Scale 的下限。

關鍵字

溶栓治療 ； 血栓溶解劑tPA ； 中風 ； 腦梗塞 ； 入院至注射血栓溶解劑時間

並列摘要

Efficacy of intravenous alteplase to treat acute ischemic stroke decreases with door-to-needle time (DNT). This study aimed to determine what led to DNT＞ 60 minutes. We analyzed the data of acute ischemic stroke patients in 2012 and 2013, and defined ＂door to all laboratory data＂ as the time needed to finish brain CT, CBC, and PT/aPTT. Then we tested whether ＂door to all laboratory data＂ time was associated with whether DNT was longer than 60 minutes. Lastly we analyzed the factors leading to DNT＞ 60 minutes. ＂Door to all laboratory data＂ time was not significantly related to whether DNT was longer than 60 minutes. Factors leading to DNT＞ 60 minutes, ＂laboratory time too long＂ corresponded to 23.8%, ＂family factor＂ 14.3%, ＂disease factor＂ 42.3%, ＂administration factor＂ 4.8%, and ＂no obvious cause＂ 14.3%. In order to further shorten the laboratory time, we should talk to family about whether to use alteplase if feasible, before the laboratory results are available. We should also measure the patients' weight, get alteplase at hand, and control the blood pressure as early as possible. Lastly, we should consider lowering or canceling the lower limit of National Institutes of Health Stroke Scale.

並列關鍵字

thrombolytic therapy ； tissue plasminogen activator (tPA) ； stroke ； brain infarction ； door to needle time (DNT)

參考文獻

Sung SF, Huang YC, Ong CT, et al: A Parallel Thrombolysis Protocol with Nurse Practitioners As Coordinators Minimized Door-to-Needle Time for Acute Ischemic Stroke. Stroke Res Treat 2011;2011:198518. doi: 10.4061/2011/198518

Hsu YC, Sung SF, Ong CT, et al: Intravenous thrombolytic therapy for acute ischemic stroke: the experience of a community hospital. Acta Neurol Taiwan 2009;18:14-20.

Lees KR, Bluhmki E, von Kummer R, et al: Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010;375:1695-703. doi: 10.1016/S0140-6736(10)60491-6

Fonarow GC, Zhao X, Smith EE, et al: Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA 2014;311:1632-40. doi: 10.1001/jama.2014.3203

Jauch EC, Saver JL, Adams HP Jr., et al: Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947. doi: 10.1161/STR.0b013e318284056a