急性腦中風患者血壓過高時給予靜脈注射組織胞漿素原活化劑之爭議

Controversy on the Usage of Intravenous Tissue Type Plasminogen Activator for Acute Stroke with Blood Pressure Protocol Violation

陳建志(Jiann-Jy Chen) ； 張馨丰(Hsin-Feng Chang) ； 陳登郎(Dem-Lion Chen) ； 馮紀新(Chi-Hsin Feng)

《北市醫學雜誌》 12卷3期 (2015/09) Pp. 75-83

https://doi.org/10.6200/TCMJ.2015.12.3.10

摘要

本文探討靜脈注射組織胞漿素原活化劑（簡稱t-PA）治療規範中的一個排除條件。一70歲男性，有高血壓及糖尿病等過去病史，因急性發作左側肢體癱瘓、感覺減弱、半忽視及中樞性面癱來診，隨即進行急性腦中風的處理流程。卻因呈現緊急高血壓，違背靜脈注射t-PA的治療規範，只能進行一般性常規治療，3日後死於基底動脈阻塞。固然基底動脈阻塞目前尚無有效的治療策略，當初是否可以忽視這一排除條件「收縮壓＞185 mmHg或舒張壓＞110 mmHg，或需要積極的治療（靜脈給藥）以降低血壓至前述界線以下」，冒險給予靜脈注射t-PA？激起了一個橫跨醫學與法律程面的議題。

關鍵字

組織胞漿素原活化劑 ； 基底動脈阻塞 ； 急性腦中風 ； 緊急高血壓 ； 仿單核准適應症外的使用

並列摘要

In this article, we discuss an exclusion criterion for the use of intravenous recombinant tissue-type plasminogen activator (t-PA) in the treatment guideline. A 70-year-old man had hypertension and diabetic mellitus. He presented an acute onset of left hemiparesis, hemihypesthesia, hemineglect and central-type facial palsy. Urgent procedures for acute stroke were performed immediately. However, the intravenous t-PA was suspended because of hypertensive emergency; he received a routine conservative supportive treatment instead. Three days later, he died of basilar artery occlusion. There is no effective treatment for basilar artery occlusion currently. An controversial issue involving medical and legal perspectives is raised on whether intravenous t-PA may be used when pretreatment systolic blood pressure exceeds 185 mmHg or diastolic blood pressure exceeds110 mmHg, or if aggressive treatment is required to reduce their blood pressure to specified limits.

並列關鍵字

recombinant tissue-type plasminogen activator ； basilar artery occlusion ； acute stroke ； hypertensive emergency ； off-label use