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卒中后动脉内溶栓疗法可获长期效益

  发表日期:2006年12月20日          【编辑录入:zsw

卒中后动脉内溶栓疗法可获长期效益

12月一期的《卒中》(Stroke)报告,卒中后采用动脉内溶栓疗法(intra-arterial thrombolysis ,IAT),其效益至少可长达2年。

Mattle医生说,“如果患者已经错过采用rtPA静脉溶栓疗法治疗的时间窗,那么IAT是我们可提供的疗法之一,并可从中获益。”

Mattle医生及其同事对发病在24小时之内的144例卒中患者采用ITA与147例采用阿斯匹林治疗的两年的结果作了比较。

卒中后24个月, IAT治疗的患者中40%患者结果满意,其余56%可生活自理。相比之政,阿斯匹林治疗组24个月后,24%患者结果良好,42%患者仍保持生活自理。

两组2年死亡率相近。IAT组为23%,阿斯匹林组为24%。

两组中NIH卒中评测高积分均可独立预测不利结果。阿斯匹林组,高血压可预测不利结果;而ITA组,高龄可预测不利结果。

研究者认为,IAT治疗的卒中患者的远期疗效与NINDS的rtPA治疗的患者及静脉溶栓疗法试验具有可比性。

显然,要回答那些患者行静脉溶栓疗法,那些应行IAT,则需要进行静脉溶栓疗法与IAT的随机试验进行比较。(SWZ译)

 

附原文:

Intra-Arterial Thrombolysis Provides Long-Term Benefit After Stroke

The benefit of intra-arterial thrombolysis (IAT) after stroke is sustained for at least 2 years, according to a report in the December issue of Stroke.

"IAT is a treatment we can offer to our patients," Dr. Heinrich P. Mattle from University of Bern, Switzerland told Reuters Health, "and patients generally benefit from IAT when the time window for treatment with intravenous thrombolysis using rtPA has already elapsed."

Dr. Mattle and colleagues compared 2-year outcomes of 144 stroke patients treated with IAT with those of 147 matching patients treated with aspirin within the first 24 hours after symptom onset.

Forty percent of patients treated with IAT had excellent outcomes 24 months after their strokes, the authors report, and 56% remained functionally independent.

By comparison, 24% of aspirin patients had an excellent outcome at 24 months, and 42% were functionally independent.

Mortality at 2 years was similar in the two groups, the researchers note, at 23% in the IAT group and 24% in the aspirin group.

A high NIH Stroke Scale score independently predicted adverse outcomes in both groups, the report indicates. Hypertension predicted adverse outcomes in the aspirin group and advancing age predicted adverse outcomes in the IAT group.

"The long-term outcome in stroke patients treated with IAT is comparable to that of patients treated in the NINDS rtPA study and observational intravenous thrombolysis trials," the investigators write.

"The open question is which patient should receive intravenous and which patient should receive IAT," Dr. Mattle said. "To answer this question randomized trials comparing intravenous thrombolysis and IAT will be needed."

Stroke 2006;37:3002-3007.



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