柏林格公司课件.pptVIP

绿色通道建设 “脑卒中”绿色通道操作指引 脑卒中绿色通道流程图 D:\快盘\科室\科研\thrombolysis_rtPA\绿色通道\广医附一院脑卒中急救绿色通道溶栓流程(2).doc 谢 谢 阐述卒中的危害。 1995年，NINDS试验有力地证明了rt-PA能使急性缺血性卒中患者获益，rt-PA作为全球第一个、也是唯一被证明可推荐用于卒中急性期溶栓治疗的药剂。 NINDS rt-PA研究证实，爱通立可增加早期神经功能改善的患者比率。从这张图中可以看出，接受治疗24小时时获得临床改善的患者比率比安慰剂组高8%。 如图所示：接受爱通立治疗的患者在24小时时的NIHSS评分为8分，比安慰剂组少4份，患者获得明显改善。 This slide compares historical estimates of 3-month outcomes after ischaemic stroke with data that have been collected in recent randomised clinical trials.5 We should bear in mind, however, that randomised clinical trials usually do not reflect the characteristics of an overall stroke population rather they represent selected stroke patient subgroups. Nevertheless, in recent years, stroke mortality has decreased in all age groups and independent of gender, except in the group of very old female patients ( 85 years). A second reminder: stroke mortality and outcome varies a great deal between countries. Mortality rates may vary between 10 and over 30% in selected statistics representing the effects of genetic influences, risk-factor distribution and prevention measures.5–6 爱通立可以显著改善患者的神经功能。NINDS rt-PA第一部分及第二部分的研究均证实，接受爱通立治疗3个月时的NIHSS评分良好转归的患者比率显著高于安慰剂组。如图所示。 The EUSI guidelines recommend rt-PA within a 3-hour time window for which it is still licensed.11 The data indicate that it may, eventually, be possible to extend this to 4.5 hours.12 However, it is essential to know when the stroke happened and if this is not clear rt-PA treatment is not possible.13 ECASS Ⅱ研究同样证实，按照修改后的Rankin 分级，发病后6小时内注射爱通立的患者在3个月时与安慰剂组相比的0，1差别=3.7%，p=0.277；0、1、2差别=8.3%，爱通立组疗效显著优于安慰剂组，p=0.024。 A comparison of the modified Rankin scale data of ECASS I and II with the NINDS trial shows that a much higher response rate and a lower mortality was found in ECASS II. The small increase of mortality in the rt-PA arm is probably explained by the small group size. The figure depicts the Forest plots for both dichotomisations of the modified Rankin scale (mRS 0–2 vs. 3–6) in the 6-hour time