JAMA:急性大血管闭塞性脑卒中患者的治疗——溶栓联合取栓 vs 单纯机械取栓(SKIP研究)

2021-01-20 MedSci原创 MedSci原创

在急性大血管闭塞性脑卒中患者中,单独进行机械血栓切除后患者的功能预后良好比例与静脉溶栓后机械取栓相当,但单独取栓组脑出血发生率较低

现行指南建议,对于症状出现后4.5小时内的大血管闭塞中风患者,先进行0.9mg/Kg体重的阿替普酶溶栓,后进行机械取栓。近年来,有研究发现,大血管闭塞中风患者直接进行机械取栓后患者的90天预后与溶栓后取栓相当。近日研究人员开展大规模非劣性对照研究,考察了单纯血栓切除与静脉溶栓联合机械取栓对患者预后的影响
 
研究于2017年1月1日至2019年7月31日在日本开展,包含23个医疗中心,204名因大血管闭塞引起的急性缺血性中风患者参与,其中101人接受单纯机械血栓切除,103人接受静脉溶栓(阿替普酶0.6 mg/kg剂量)后机械血栓切除。研究的主要终点为功能预后良好,定义Rankin评分0-2,关键的次要终点包括90天死亡率和36小时内的任何脑出血和症状性脑出血。
 
患者平均年龄74岁,男性占62.7%,平均NIHSS得分为18,所有患者都完成了试验。单纯机械取栓组60例(59.4%)患者预后良好,而静脉溶栓-机械血栓切除术联合组59例(57.3%),组间患者功能预后良好的比例无显著性差异(差异:2.1%)。组间在7个次要疗效终点和4个安全性终点中,10个无显著差异,包括90天死亡率(8例[7.9%]vs9例[8.7%];差异:-0.8%,OR:0.90),但单纯机械取栓组患者的脑出血发生率低于联合治疗组(34例[33.7%] vs 52例[50.5%];差异:-16.8%;优势比:0.50),组间症状性脑出血率无显著差异(6例[5.9%] vs8例[7.7%];差异:-1.8%;比值比:0.75)。
 
研究认为,在急性大血管闭塞性脑卒中患者中,单独进行机械血栓切除后患者的功能预后良好比例与静脉溶栓后机械取栓相当,但单独取栓组脑出血发生率较低
 
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createdBy=091e27733095, createdName=weihongyv, createdTime=Thu Feb 25 06:16:21 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1722296, encodeId=81501e22296f0, content=<a href='/topic/show?id=e05e522581c' target=_blank style='color:#2F92EE;'>#急性大血管闭塞性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52258, encryptionId=e05e522581c, topicName=急性大血管闭塞性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e55433252818, createdName=xuyu, createdTime=Sun May 23 08:16:21 CST 2021, time=2021-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720364, encodeId=53ca1e203642c, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38007, encryptionId=b97f3800ee0, topicName=取栓)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99077483919, createdName=1249862am74(暂无昵称), createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578906, encodeId=260215e8906f9, content=<a href='/topic/show?id=80286123908' target=_blank style='color:#2F92EE;'>#机械取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61239, encryptionId=80286123908, topicName=机械取栓)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de0216462203, createdName=ms2186806800017884, createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), 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  5. [GetPortalCommentsPageByObjectIdResponse(id=2009872, encodeId=569f20098e232, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Fri Oct 01 19:16:21 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679156, encodeId=b84f16e9156d4, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38007, encryptionId=b97f3800ee0, topicName=取栓)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99077483919, createdName=1249862am74(暂无昵称), createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578906, encodeId=260215e8906f9, content=<a href='/topic/show?id=80286123908' target=_blank style='color:#2F92EE;'>#机械取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61239, encryptionId=80286123908, topicName=机械取栓)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de0216462203, createdName=ms2186806800017884, createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), 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beContent=null, objectType=article, channel=null, level=null, likeNumber=167, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200831/c8dbac41da994ba0985636b0b4468384/d0c0ab57e8594d71b12e5e96a9e237da.jpg, createdBy=b9385199067, createdName=tckey, createdTime=Wed Jan 20 22:14:25 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
    2021-08-30 kkunny
  6. 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  7. 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GetPortalCommentsPageByObjectIdResponse(id=1026752, encodeId=a3161026e52e1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, 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=健健, createdTime=Wed Jan 20 23:16:21 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036409, encodeId=a1fc1036409ce, 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=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 23:16:21 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918560, encodeId=6608918560e8, content=国内去年就发表过类似研究,多中心的, beContent=null, objectType=article, channel=null, level=null, likeNumber=167, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200831/c8dbac41da994ba0985636b0b4468384/d0c0ab57e8594d71b12e5e96a9e237da.jpg, createdBy=b9385199067, createdName=tckey, createdTime=Wed Jan 20 22:14:25 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=2009872, encodeId=569f20098e232, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Fri Oct 01 19:16:21 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679156, encodeId=b84f16e9156d4, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Thu Feb 25 06:16:21 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1722296, encodeId=81501e22296f0, content=<a href='/topic/show?id=e05e522581c' target=_blank style='color:#2F92EE;'>#急性大血管闭塞性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52258, encryptionId=e05e522581c, topicName=急性大血管闭塞性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e55433252818, createdName=xuyu, createdTime=Sun May 23 08:16:21 CST 2021, time=2021-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720364, encodeId=53ca1e203642c, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Thu Jul 29 23:16:21 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706166, encodeId=f8321e06166c1, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Aug 30 00:16:21 CST 2021, time=2021-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479086, encodeId=c0bd14e90863c, content=<a href='/topic/show?id=b97f3800ee0' target=_blank style='color:#2F92EE;'>#取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38007, encryptionId=b97f3800ee0, topicName=取栓)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99077483919, createdName=1249862am74(暂无昵称), createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578906, encodeId=260215e8906f9, content=<a href='/topic/show?id=80286123908' target=_blank style='color:#2F92EE;'>#机械取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61239, encryptionId=80286123908, topicName=机械取栓)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de0216462203, createdName=ms2186806800017884, createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026752, encodeId=a3161026e52e1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, 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=健健, createdTime=Wed Jan 20 23:16:21 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036409, encodeId=a1fc1036409ce, 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=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 23:16:21 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918560, encodeId=6608918560e8, content=国内去年就发表过类似研究,多中心的, beContent=null, objectType=article, channel=null, level=null, likeNumber=167, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200831/c8dbac41da994ba0985636b0b4468384/d0c0ab57e8594d71b12e5e96a9e237da.jpg, createdBy=b9385199067, createdName=tckey, createdTime=Wed Jan 20 22:14:25 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
    2021-01-20 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=2009872, encodeId=569f20098e232, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Fri Oct 01 19:16:21 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679156, encodeId=b84f16e9156d4, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Thu Feb 25 06:16:21 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1722296, encodeId=81501e22296f0, content=<a href='/topic/show?id=e05e522581c' target=_blank style='color:#2F92EE;'>#急性大血管闭塞性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52258, encryptionId=e05e522581c, topicName=急性大血管闭塞性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e55433252818, createdName=xuyu, createdTime=Sun May 23 08:16:21 CST 2021, time=2021-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720364, encodeId=53ca1e203642c, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Thu Jul 29 23:16:21 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706166, encodeId=f8321e06166c1, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Aug 30 00:16:21 CST 2021, time=2021-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479086, encodeId=c0bd14e90863c, content=<a href='/topic/show?id=b97f3800ee0' target=_blank style='color:#2F92EE;'>#取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38007, encryptionId=b97f3800ee0, topicName=取栓)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99077483919, createdName=1249862am74(暂无昵称), createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578906, encodeId=260215e8906f9, content=<a href='/topic/show?id=80286123908' target=_blank style='color:#2F92EE;'>#机械取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61239, encryptionId=80286123908, topicName=机械取栓)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de0216462203, createdName=ms2186806800017884, createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026752, encodeId=a3161026e52e1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, 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=健健, createdTime=Wed Jan 20 23:16:21 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036409, encodeId=a1fc1036409ce, 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=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 23:16:21 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918560, encodeId=6608918560e8, content=国内去年就发表过类似研究,多中心的, beContent=null, objectType=article, channel=null, level=null, likeNumber=167, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200831/c8dbac41da994ba0985636b0b4468384/d0c0ab57e8594d71b12e5e96a9e237da.jpg, createdBy=b9385199067, createdName=tckey, createdTime=Wed Jan 20 22:14:25 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
    2021-01-20 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

  10. [GetPortalCommentsPageByObjectIdResponse(id=2009872, encodeId=569f20098e232, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Fri Oct 01 19:16:21 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679156, encodeId=b84f16e9156d4, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Thu Jul 29 23:16:21 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706166, encodeId=f8321e06166c1, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Aug 30 00:16:21 CST 2021, time=2021-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479086, encodeId=c0bd14e90863c, content=<a href='/topic/show?id=b97f3800ee0' target=_blank style='color:#2F92EE;'>#取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38007, encryptionId=b97f3800ee0, topicName=取栓)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99077483919, createdName=1249862am74(暂无昵称), createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578906, encodeId=260215e8906f9, content=<a href='/topic/show?id=80286123908' target=_blank style='color:#2F92EE;'>#机械取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61239, encryptionId=80286123908, topicName=机械取栓)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de0216462203, createdName=ms2186806800017884, createdTime=Fri Jan 22 11:16:21 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026752, encodeId=a3161026e52e1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, 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=健健, createdTime=Wed Jan 20 23:16:21 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036409, encodeId=a1fc1036409ce, 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=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 23:16:21 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918560, encodeId=6608918560e8, content=国内去年就发表过类似研究,多中心的, beContent=null, objectType=article, channel=null, level=null, likeNumber=167, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200831/c8dbac41da994ba0985636b0b4468384/d0c0ab57e8594d71b12e5e96a9e237da.jpg, createdBy=b9385199067, createdName=tckey, createdTime=Wed Jan 20 22:14:25 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
    2021-01-20 tckey

    国内去年就发表过类似研究,多中心的

    0

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在过去的十年里,越来越多的农村急性缺血性中风和短暂性脑缺血发作患者接受了经过认证的专业治疗,但在获得溶栓治疗(如阿替普酶)和治疗结果方面的差距仍然存在

Lancet Neurol:超声辅助静脉阿替普酶溶栓的意义

阿替普酶是唯一被批注用于急性缺血性卒中再灌注治疗的药物,越早使用获益越大。但是,尽管采取了药物治疗仍然有一半的患者遗留残疾或死亡,这是由于缺血性损伤的严重程度以及对静脉溶栓的反应较差。

Lancet:阿替普酶对中风时间不明患者的疗效及安全性研究

研究认为,对于中风发作时间不明,且影像学结果存在矛盾的患者,静脉阿替普酶治疗可有助于改善患者预后功能,但治疗导致的症状性颅内出血、严重残疾以及死亡风险也较高

Lancet:中风4.5小时后接受阿替普酶溶栓仍可以获得较好的功能预后

中风发作后4.5-9小时的缺血性卒中患者接受阿替普酶治疗后,其功能预后优于安慰剂组。尽管阿替普酶治疗增加有症状脑出血风险,但这不能否定溶栓治疗的整体效益

Lancet:卒中4.5小时后,是否还可用阿替普酶溶栓?

中风后用阿替普酶溶解血栓的推荐时间为中风后0-4.5小时内。卒中4.5小时后是否还可采用阿替普酶溶栓治疗?晨起卒中患者是否也可受益于阿替普酶溶栓?研究人员检索2006年1月1日-2019年3月1日期间发表的关于缺血性卒中发生4.5小时后予以阿替普酶或安慰剂治疗或晨起卒中予以阿替普酶或安慰剂治疗,并有造影MRI或CT影像资料的研究。主要评估指标是3个月时的功能性预后。研究人员筛选到3个符合要求的试验

NEJM:大血管闭塞性急性缺血性卒中患者血栓切除前是否需要溶栓治疗

对于大血管闭塞性急性缺血性卒中患者,单纯接受血栓切除与静脉注射阿替普酶联合血栓清除对患者功能预后的影响无显著差异