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題名 | 臺灣急性缺血性腦中風的靜脈注射血栓溶解劑治療=Intravenous Thrombolytic Therapy in Acute Ischemic Stroke in Taiwan |
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作者 | 翁文章; 陸仁安; 陳昌明; 胡漢華; 連立明; 陳俊榮; 邱浩彰; 鍾國屏; 郭泰宏; 安茂沅; 張谷州; 陳廷耀; 劉嘉為; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 3:2 2001.04[民90.04] |
頁次 | 頁112-120 |
分類號 | 415.922 |
關鍵詞 | 靜脈注射; 血栓溶解劑; 缺血性腦中風; Intravenous; Thrombolysis; Ischemic stroke; |
語文 | 中文(Chinese) |
中文摘要 | 本觀察之目的在探討臺灣的經靜脈注射(IV)的血栓溶解劑Recombinant tissue plasminogen (rt-PA),於1996年美國通過使用後,陸續有數個國家跟進通過使用。這是世上第一種證實能有效治療缺血性腦中風的藥物;但是,使用規範嚴格且限制多,引起的出血副作用也是現有藥物中最多。自85年1月至89年3月,本觀察共收集到臺灣地區六家醫院34位接受此種治療的病人。病人的評估及以治療的相關處理遵照美國心臟學會建議的治療準則實施。IV rt-PA劑量不超過0.9ng/kg,總量不超過90mg,其中的10%由靜脈注射,剩餘的90%在一個小時之內由靜脈滴注完畢;治療開始時間必須在病發後的三個小時之內。結果顯示,共有21位女性及13位男性病人接受治療,平均年齡67.1歲。IV-PA使用劑量介於0.6至0.9mg/kg。治療後有症狀腦部出血2人(5.9%),無症狀腦部出血2人(5.9%),其他部位出血2人(5.9%)。病發3個月後:10個人能獨立自我照顧,15人依賴他人照顧;死亡9人(26.5%)。神經缺員住院日19.9分,住院後第一天17.2分,第七天13.5分及第3個月8.7分。本研究顯示:IV rt-PA治療急性缺血性腦中共的使用經驗在臺灣仍然有限,但是這六家醫院有能力執行急性腦中風治療。本觀察個案的中風嚴重度比國外各研究嚴重,使用rt-PA的劑量較建議量低。在IV rt-PA尚未在登記治療急性缺血性腦中風適應症之前,推動有對照組的治療研究;在IV rt-PA登記此適應症之後,推動一個登錄研究來追蹤臺灣IV rt-PA治療的個案,將有助於進一步釐清此種治療在臺灣的安全性,治療時機以及治療效果。 |
英文摘要 | This observation described the experience of treating acute ischemic stroke within three hours after onset by intravenous (IV) recombinant tissue plasminogen (rt-PA) in Taiwan. The FDA USA approved IV rt-PA for clinical use in June 1996, followed by a couple countries. This is the first drug effective in treating ischemic stroke. Due to the potential bleeding side effect, this drug cannot be prescribed with impunity. From January 1996 to March 2000, this observation collected 34 patients received IV rt-PA according to the guidelines of American Heart Association: rt-PA should be administered intravenously in dose of 0.9 mg/kg to a maximum of 90 mg, with an initial 10% given as a bolus over 1-2 minutes and the remainder of the dose infused over 60 minutes. The drug must be given within 3 hours of stroke onset. There were 21 women and 13 men, average 67.1 years old, received the therapy. The doses used were between 0.6-0.9 mg/kg. There were 2 (5.9%) symptomatic intracranial hemorrhage 2 (5.9%) asymptomatic intracranial hemorrhage, and 2 (5.9%0 other hemorrhage. At three month after the treatment, 10 patients could be independent, 15 were dependent and 9 (26.5%) were dead. Neurological deficits assessed by national Instituted of Health Stroke Scale at baseline, 24 hours after the therapy. 7 days and 3 months were 19.9, 17.2, 13.5 8.7 points at survivors respectively. This observation described the limited experience of treating acute ischemic stroke by IV rt-PA. The severity of this group of patients were worse than most of other studies. Before the indication registered for treating acute ischemic stroke by IV rt-PA, a controlled trial might be worth trying. After the indication registered, a registration of patients treated by this therapy is important for the safety and efficacy. |
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