急性缺血性卒中的治疗相关问题.pptx

急性缺血性卒中的治疗相关问题 天津市环湖医院 纪 勇Stroke FactsA leading cause of death in the United States795,000 Americans suffer strokes each year134,000 deaths each year - From 1996 to 2006, the stroke death rate fell 33.5% and number of deaths fell by 18.4%6,400,000 stroke survivorsStroke trend in Japan1950-1981 Stroke was the leading cause of death 1981-1985 cancer was the leading cause of deathFrom 1985 Stroke is the third leading cause of death WHO公布的资料2012年：中国Stroke的发病率185～219/10万患病率719～745/10万死亡率116～141/10万卫生部：脑卒中已成中国位居第一致病死因脑卒中MONICA研究结果，中国脑卒中正以每年近9%的速度上升，它已经为中国位居第一的致病死因。Stroke Recovery10% of stroke survivors recover almost completely25% recover with minor impairments40% experience moderate to severe impairments requiring special care10% require care within either a skilled-care or other long-term care facility15% die shortly after the stroke AIS治疗4.5小时， IV r-TPA is the current gold standard IV thrombolytic therapy remains the cornerstone of evidence-based acute ischemic stroke therapy (Class I; level A)6.4% complication of symptomatic intracranial hemorrhage (sICH) Intravenous rTPAPool analysis of NINDS/ECASS/ATLANTISNINDS(美国）Review of Thrombolysis for AISECASS(欧洲)ECASS III ECASS II(欧洲/大洋洲)EPITHET ATLANTIS20062005199519961997200020012002200420082007199819992003 美国FDA批准STARS(美国)CASES(加拿大)SITS-ISTR 加拿大批准 德国批准SITS-MOST(欧盟) 全欧洲EMEA批准NINDS Trial Results Percentage with favorable outcomeNo.of patients: t-PA Placebo 312 157 145Modified Rankin Scale 40 % 28 %Glasgow Outcome Scale 43 32 %NIHSS 34 20 %Symptomatic ICH (within 36 hr) 6.4% 0.6 %Death (by 90 days) 17% 21 % NEJM 1995; 333:1581-7Phase IV vs. NINDS DataRe-analysis and Meta-analysis Re-analysis Meta-analysisPatients, n 312 2639 Median NIHSS14 14 Very Favorable39.037.1 Outcome %Sym