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JAMA Neurol:院内中风患者血管内再灌注治疗率及功能预后研究

2020-09-28 MedSci原创 MedSci原创

住院脑卒中发病率呈现出上升趋势,与院外脑卒中发作相比,院内发病患者的再灌注延迟时间较长,功能预后较差

统计发现,有相当大比例的急性缺血性脑卒中发生在患者住院期间,近日研究人员评估了静脉和血管内再灌注疗法治疗住院脑卒中的时间变化趋势。

本次回顾性队列研究分析了2008年1月至2018年9月在GetWithGuidelines-Stroke国家数据库中收集的接受脑卒中治疗的患者数据,患者在院内或院外发病。研究的主要终点为血管内再灌注治疗的时间变化趋势、质量、功能结果与关键患者特征,共患病和治疗之间的关联。

在67493例住院脑卒中患者中,与仅接受静脉溶栓(平均年龄72岁,53.2%女性)的患者相比,接受血管内治疗(平均年龄69岁,49.8%女性)患者的血管危险因素发生率较高(标准化平均差>10%),但年龄或性别无显著性差异。10481例(15.5%)接受静脉溶栓治疗,2494例(3.7%)接受血管内治疗。与2008年相比,2018年住院脑卒中患者的比例增加(3.5% vs 2.7%),住院脑卒中患者使用静脉溶栓(19.1% vs 9.1%)和血管内治疗(6.4% vs 2.5%)的比例增加,其中2015年接受血管内治疗的患者比例显著增加。与接受静脉溶栓治疗的院外脑卒中患者相比,住院患者从中风识别到头颅成像(33 vs 16分钟)和溶栓治疗(81[ vs 60分钟)的中位(IQR)时间较长。调整后,与院外发病并接受静脉溶栓治疗的患者相比,接受静脉溶栓治疗的住院脑卒中患者出院后,无法独立行走、死亡或接受临终关怀(调整后的比值比为1.39)的风险增加,接受血管内治疗的住院脑卒中患者的预后也较差。

研究发现,住院脑卒中发病率呈现出上升趋势,与院外脑卒中发作相比,院内发病患者的再灌注延迟时间较长,功能预后较差。

原始出处:

Feras Akbik et al. Trends in Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era.JAMA Neurol. September 21, 2020.

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    2021-05-21 yinhl1978
  2. [GetPortalCommentsPageByObjectIdResponse(id=2001117, encodeId=65cb200111ea2, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri May 21 03:43:52 CST 2021, time=2021-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925965, encodeId=d152925965e1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3601615208, createdName=dearluodi, createdTime=Sun Feb 21 02:31:36 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=889445, encodeId=d075889445aa, content=考虑到非标准化的疾病标准,应考虑进一步设计良好的前瞻性试验以证实这些结果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b58d5402080, createdName=咻凡, createdTime=Wed Sep 30 16:59:41 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1489083, encodeId=ac00148908308, content=<a href='/topic/show?id=7b2130649c9' target=_blank style='color:#2F92EE;'>#再灌注治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30649, encryptionId=7b2130649c9, topicName=再灌注治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e33a8492666, createdName=xjy05, createdTime=Wed Sep 30 10:43:52 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492862, encodeId=4dee1492862ca, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Wed Sep 30 10:43:52 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1538097, encodeId=5c89153809ef2, content=<a href='/topic/show?id=e835226210e' target=_blank style='color:#2F92EE;'>#中风患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22621, encryptionId=e835226210e, topicName=中风患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1b5612933772, createdName=sunylz, createdTime=Wed Sep 30 10:43:52 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036287, encodeId=b584103628e39, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Sep 28 22:43:52 CST 2020, time=2020-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1045982, encodeId=9cdc10459825d, content=中风是俗称,应该称为缺血性卒中吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=guging, createdTime=Mon Sep 28 22:43:52 CST 2020, time=2020-09-28, status=1, ipAttribution=)]
    2021-02-21 dearluodi

    学习

    0

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    2020-09-30 咻凡

    考虑到非标准化的疾病标准,应考虑进一步设计良好的前瞻性试验以证实这些结果。

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=2001117, encodeId=65cb200111ea2, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri May 21 03:43:52 CST 2021, time=2021-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925965, encodeId=d152925965e1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3601615208, createdName=dearluodi, createdTime=Sun Feb 21 02:31:36 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=889445, encodeId=d075889445aa, content=考虑到非标准化的疾病标准,应考虑进一步设计良好的前瞻性试验以证实这些结果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b58d5402080, createdName=咻凡, createdTime=Wed Sep 30 16:59:41 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1489083, encodeId=ac00148908308, content=<a href='/topic/show?id=7b2130649c9' target=_blank style='color:#2F92EE;'>#再灌注治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30649, encryptionId=7b2130649c9, topicName=再灌注治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e33a8492666, createdName=xjy05, createdTime=Wed Sep 30 10:43:52 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492862, encodeId=4dee1492862ca, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Wed Sep 30 10:43:52 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1538097, encodeId=5c89153809ef2, content=<a href='/topic/show?id=e835226210e' target=_blank style='color:#2F92EE;'>#中风患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22621, encryptionId=e835226210e, topicName=中风患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1b5612933772, createdName=sunylz, createdTime=Wed Sep 30 10:43:52 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036287, encodeId=b584103628e39, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Sep 28 22:43:52 CST 2020, time=2020-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1045982, encodeId=9cdc10459825d, content=中风是俗称,应该称为缺血性卒中吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=guging, createdTime=Mon Sep 28 22:43:52 CST 2020, time=2020-09-28, status=1, ipAttribution=)]
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    2020-09-28 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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    2020-09-28 guging

    中风是俗称,应该称为缺血性卒中吧

    0

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急性缺血性卒中发病前存在残疾者往往被拒绝静脉溶栓(IVT)治疗。为了验乞发病前残疾患者采用 IVT 和良好临床预后之间的关系,并且不会增加死亡率,2019年11月来自德国的Christoph Gumbinger等在 Neurology 上公布了他们的研究结果。

Stroke:新型口服抗凝剂不是静脉溶栓的禁忌症?

2020年2月来自美国的Shima Shahjouei等在 Stroke 上公布了他们的系统性综述和 meta 分析结果,他们对 tPA 静脉溶栓前接受 DOAC 抗凝者 IVT 的安全性进行了分析。

Neurology:静脉溶栓发生远隔部位脑出血的原因

尽管增加脑出血(ICH)的风险,但已证实在脑缺血症状发作后的最初4.5小时内IV给予重组组织纤溶酶原激活物(rtPA)的益处。

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