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題名 | 臺灣以靜脈注射rt-PA治療缺血性腦中風的現況調查=Thrombolytic Therapy for Ischemic Stroke in Taiwan Using Intravenous rt-PA |
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作者 | 趙君傑; 陳郁菁; 張志華; 連楚明; 王宗倫; 唐高駿; Chao, Chun-chieh; Chen, Yu-ching; Chong, Chee-fah; Lin, Aming Chor-ming; Wang, Tzong-luen; Tang, Gau-jun; |
期刊 | 中華民國急救加護醫學會雜誌 |
出版日期 | 20061200 |
卷期 | 17:4 民95.12 |
頁次 | 頁139-145 |
分類號 | 415.922 |
語文 | chi |
關鍵詞 | 缺血性腦中風; 血栓溶解劑; 合成的組織胞漿素原活化劑; rt-PA; Ischemic stroke; Thrombolytic; Recombinant tissue plasminogen activator; |
中文摘要 | 背景:雖然使用靜脈注射血栓溶解劑(合成的組織胞漿素原活化劑,rt-PA)是目前唯一可以有效治療急性缺血性腦中風的藥物,其臨床使用率依然偏低,多數醫師仍持保留態度。本研究利用問卷調查的方式,來了解臺灣的臨床醫師使用rt-PA治療急性缺血性腦中風之實際情形,也針對其不常被使用之原因作進一步探討。 方法:本研究針對臺灣各醫學中心及區域醫院的急診醫師及神經科醫師進行問卷調查。問卷內容除了探討臨床醫師使用rt-PA治療腦中風之頻率,也請受訪醫師依偏好選答其不考慮使用rt-PA治療腦中風的原因,並採用Likert Scale來做量化統計。 結果:總共發出了200 份問卷,有效回收率32 %。受訪醫師中,563 %為急診醫師、437 %為神經科醫師。只有266 %的醫師表示每年會使用5 次以上rt-PA於治療腦中風。絕大部份(891 % )的醫師都認為病人無法接受rt-PA 治療之原因是因為不能及時被送達醫院。只有281 %的醫師認為所屬機構之神經外科無法配合處理可能發生之併發症。此外,有771 %的醫師認為自己缺乏相關的訓練課程及64 %的醫師認為使用rt - PA 之併發症高於期望值。將急診和神經科兩組醫師的資料作比對的結果,並無發現有顯著的差異。結論:在臺灣使用靜脈注射rt 一PA 來治療急性缺血性腦中風的情形並不普遍,原因依序為:病患太晚就醫、醫師缺乏相關的教育訓練、醫師擔心發生出血之併發症以及少數醫院的神經外科醫師無法及時支援。 |
英文摘要 | Background: Although intravenous recombinant tissue plasminogen activator (rt-PA) is now approved for treatment of acute ischemic stroke, most physicians are still reluctant to use it. In this study, we assess the frequency and limitations of rt-PA stroke therapy in Taiwan. Methods: A questionnaire was designed to assess the frequency of stroke treatment by rt-PA. The factors that cause reluctance among clinicians to provide rt-PA to stroke patients were also evaluated using a Likert scale score. Results: A total of 200 questionnaires delivered and 32% were recovered for analysis. Among the respondents, 56.3% were emergency physicians and 43.7% were neurologists. Only 26.6% of the respondents had provided rt-PA to stroke patients more than five times annually. Most physicians (89.1%) considered that the poor rate of use of this thrombolytic therapy was a result of late presentation of patients at the emergency department. Other causes included a lack of available neurosurgical backup (28.1%), fear of bleeding complications (64%), and a lack of training and education (77.1%). Comparison between the emergency physicians and neurologists showed no significant difference. Conclusion: Thrombolytic stroke therapy using intravenous rt-PA remains under-practiced in Taiwan due to a number of factors, namely, late presentation, a lack of training and education, safety concerns and in some institutes, a lack of neurosurgical backup. |
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