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溶栓时间窗延长至4.5h并没有影响开始溶栓(door-to-needle)的时间

时间:2011-08-16 11:51来源:卒中网 作者:admin 点击:

6月28日《stroke》杂志在线发表了瑞典一卒中登记研究,结果表明:尽管2008年ECASS III发表,将溶栓时间窗从3小时延长至4.5小时,但是这并没有影响从入院至开始溶栓的时间。

研究分析了从2003年1月-2010年6月,76个瑞典医院,共92,150例年龄在18-80岁的急性缺血性卒中入院患者。

研究发现,在3-4.5小时内溶栓率从ECASS III发表前的0.5%升高到2010年的2.1%。发病3小时内的溶栓率从2003年的0.9%提高到2008年的6.6%,而后一直稳定在6%。尽管至2008年底,对溶栓时间窗扩大至4.5h进行了全国范围内的快速宣传,但从入院至开始溶栓的平均时间(door-to-needle)在2008年前后一直保持在66~69分钟,从未改变(P=0.06)。

Effects of Extending the Time Window of Thrombolysis to 4.5 Hours

Observations in the Swedish Stroke Register (Riks-Stroke)

Kjell Asplund, MD; Eva-Lotta Glader, MD; Bo Norrving, MD; Marie Eriksson, PhD;

for the Riks-Stroke Collaboration

+ Author Affiliations

1.       From the Department of Public Health and Clinical Medicine (K.A., E.-L.G.), Umeå University, Umeå, Sweden; the Department of Neurology (B.N.), University Hospital, Lund, Sweden; and the Department of Statistics (M.E.), Umeå University, Umeå, Sweden.
1.       Correspondence to Marie Eriksson, PhD, Department of Statistics, Umeå University, SE-901 87 Umeå, Sweden. E-mail marie.eriksson@stat.umu.se

Background and Purpose—The European Cooperative Acute Stroke Study (ECASS) III trial and Safe Implementation of Thrombolysis in Stroke–International Stroke Thrombolysis Register (SITS-ISTR) data were published in 2008. Riks-Stroke, the Swedish Stroke Register, was used to explore how thrombolysis in the 3- to 4.5-hour window has been spread in different hospitals and patient groups and what effects this has had on treatment within 3 hours.

Methods—All 76 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. During the study period, January 2003 to June 2010, 92 150 18- to 80-year-old patients were hospitalized for acute ischemic stroke.

Results—After the publication of the ECASS III results in the third quarter of 2008, thrombolysis in the 3- to 4.5-hour window increased from 0.5% before publication to 2.1% in 2010. Thrombolysis in the 3- to 4.5-hour window spread somewhat faster in men than women (P=0.04) but at a similar rate in different age groups. The use of thrombolysis within 3 hours after onset of symptoms increased successively from 0.9% in 2003 to 6.6% in late 2008 and then it stabilized at 6%. The median time from arrival to the hospital to start of treatment remained unchanged at 66 to 69 minutes before and after 2008 (P=0.06).

Conclusions—Since the end of 2008, there has been a rapid nationwide dissemination of thrombolysis in the 3- to 4.5-hour window, whereas rates in the <3-hour window have leveled off. The extended time window has not affected door-to-needle time.
 

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