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【medical-news】急性卒中患者静脉注入 Rt-PA 后再予
By Megan Rauscher
NEW YORK (Reuters Health) Jan 19 - When necessary, administering intra-arterial thrombolysis after a full dose of intravenous recombinant tissue plasminogen activator (IV rt-PA) appears to be safe in patients with acute ischemic stroke, and it leads to a high rate of recanalization and favorable outcome, according to a report in the January issue of Stroke.
The finding is based on 69 consecutive acute ischemic stroke patients treated with intra-arterial thrombolytics after failing to respond adequately to 0.9 mg/kg IV rt-PA.
"A subset of patients with severe stroke who do not respond to IV rt-PA may benefit from intra-arterial 'rescue' therapy," Dr. James C. Grotta from University of Texas Health Science Center, Houston, commented to Reuters Health.
"However, there is concern that adding intra-arterial therapy on top of IV rt-PA might be too risky, particularly leading to unacceptable bleeding complications," he said. "Our study reassures doctors in the ED that they can give the full, effective, approved dose of IV rt-PA, and still be able to take the patient for intra-arterial therapy later."
In the 69 patients analyzed, IV rt-PA was given a median of 120 minutes after stroke onset and intra-arterial thrombolytics (reteplase, alteplase or urokinase) a median of 285 minutes after stroke onset.
According to the team, symptomatic intracranial bleeding occurred in only 4 of 69 patients (5.8%); 3 episodes were fatal. Recanalization was achieved in 50 patients (72.5%) and a favorable outcome -- discharge to home or inpatient rehabilitation service -- occurred in 38 patients (55%).
"Pilot studies have been done showing the safety of giving intra-arterial therapy after low dose IV rt-PA," Dr. Grotta mentioned. "However, because they are receiving lower than approved doses of IV rt-PA, such patients may not get the best chance of responding to full dose IV rt-PA."
"Our study shows that it is probably safe to give full dose IV rt-PA and then take the patient for intra-arterial therapy" if needed, he concluded.
Stroke 2007;38:80-84.
[url] http://www.medscape.com/viewarticle/551044 [/url] 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Intra-Arterial Thrombolysis Safe After Intravenous Rt-PA in Acute Stroke
急性卒中患者静脉注入 Rt-PA 后再行动脉溶栓是安全的
By Megan Rauscher
NEW YORK (Reuters Health) Jan 19 - When necessary, administering intra-arterial thrombolysis after a full dose of intravenous recombinant tissue plasminogen activator (IV rt-PA) appears to be safe in patients with acute ischemic stroke, and it leads to a high rate of recanalization and favorable outcome, according to a report in the January issue of Stroke.
纽约（路透社健康资讯）1月19日讯——据1月份发表的《中风杂志》的一篇文章报道，当必要的时候，对急性缺血性中风患者，全量静脉内应用重组组织型纤维蛋白酶原激活剂(rt-PA)后施行动脉内溶栓是安全的，这可导致高的血管再通率和有益的结果。
The finding is based on 69 consecutive acute ischemic stroke patients treated with intra-arterial thrombolytics after failing to respond adequately to 0.9 mg/kg IV rt-PA.
该结论是建立在对静脉内应用0.9 mg/kg rt-PA无反应后动脉内溶栓治疗的69例连续急性缺血性中风病例的结果之上的。
"A subset of patients with severe stroke who do not respond to IV rt-PA may benefit from intra-arterial 'rescue' therapy," Dr. James C. Grotta from University of Texas Health Science Center, Houston, commented to Reuters Health.
德克萨斯大学休斯敦保健学中心的James C. Grotta博士在路透社健康资讯栏目发表评论道：“对静脉内应用rt-PA无反应的重度中风患者可以从动脉内“救援疗法”中获益。
"However, there is concern that adding intra-arterial therapy on top of IV rt-PA might be too risky, particularly leading to unacceptable bleeding complications," he said. "Our study reassures doctors in the ED Emergency Department [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-02-28 17:11
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