透過您的圖書館登入
IP:34.204.196.206

摘要


腦血管疾病依據我國衛生福利部數據,一直是我國10大死因第二至四位,此病處理重點在於掌握黃金搶救時機,以降低病人失能與死亡率,也因此腦血管疾病為一全球性關注的議題,於過去多年來,依然將血栓溶解劑的使用限定於4.5小時,目前許多的研究致力於藉由影像醫學將腦部缺血半影區(penumbra)顯示出來,再評估各別風險後,延長可以施打靜脈血栓溶解劑(rt-PA)的時間。依據今年新英格蘭醫學雜誌(The New England Journal of Medicine)5月發表的研究結果,將病人以出現中風症狀4.5~9小時或起床後有中風症狀不確定正確發病時間者,並且接受影像醫學如腦部電腦斷層灌注攝影(perfusion scan)或,將其分為兩組,一組接受靜脈血栓溶解劑(alteplase)的施打為介入組,一組則為安慰組。以病人發病第90天的modified Rankin Scale(mRS)分數為0及1分的比例為主要指標(primary outcome),以功能改善(functional improvement)、功能獨立(functional independence)、24小時的再灌注百分比(percentage of reperfusion)為次要指標,以90天內的死亡人數比例及於36小時內出現有症狀的腦出血比例,作為安全指標(safety outcome)。結論為介入組有比較高的比例沒有或輕度神經學缺損,但是有比較多的病例出現有症狀的腦出血。以影像學為基礎引導是否施打靜脈血栓溶解劑,作為未來中風病人可否受益於靜脈血栓溶解劑的曙光。

參考文獻


Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 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 2018;49:e46-110.
Davis SM, Donnan GA, Parsons MW, et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 2008;7:299-309.
Albers GW, Thijs VN, Wechsler L, et al. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE)study. Ann Neurol 2006;60:508-17.
Ma H, Wright P, Allport L, et al. Salvage of the PWI/DWI mismatch up to 48 h from stroke onset leads to favorable clinical outcome. Int J Stroke 2015;10:56570.
Markus R, Reutens DC, Kazui S, et al. Hypoxic tissue in ischaemic stroke: persistence and clinical consequences of spontaneous survival. Brain 2004;127:1427-36.

延伸閱讀