急性缺血性卒中静脉溶栓前是否需等待血小板计数和凝血功能指标  

Is it necessary to wait for platelet count and coagulation results before intravenous thrombolysis in acute ischemic stroke ？

作　　者：杨璐萌[1] 程忻[1] 凌倚峰[1] 方堃[1] 曹文杰[1] 董强[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040

出　　处：《中华神经科杂志》2014年第7期464-468,共5页Chinese Journal of Neurology

基　　金：上海市科委西医引导类项目（124119a8100）;上海市公共卫生体系建设三年行动计划（GW3-18）

摘　　要：目的 明确急性缺血性卒中（acute ischemic stroke,AIS）患者血小板减少以及凝血功能异常的发生率;探讨不等待该结果即开始静脉溶栓能否缩短入院至溶栓时间（DNT）,对溶栓的安全性是否造成影响.方法 回顾性分析2009年1月至2013年3月复旦大学附属华山医院神经内科收治的发病在12h内的AIS和短暂性脑缺血发作（TIA）患者,观察血小板减少及凝血功能异常的发生率.回顾性分析同期予重组组织型纤溶酶原激活物（rt-PA）静脉溶栓的患者,自2012年6月26日起,溶栓治疗急诊流程进一步改进,排除相关病史用药史并经患者知情同意后,不等待血常规及凝血功能报告即开始行rt-PA静脉溶栓,按照是否等待血小板及凝血功能报告分为等待组（83例）与不等待组（37例）,比较两组DNT、疗效及安全性.结果 共纳入发病在12h内的AIS和TIA患者298例,其中8例存在血小板减少或凝血功能异常.行静脉溶栓者120例,不等待组DNT较等待组明显缩短（59 min与90 min;U=870.000,P＜0.01）.两组早期疗效、症状性脑出血发生率、7d病死率和3个月良好预后比例差异无统计学意义.结论 AIS患者早期血小板减少和凝血功能异常发生率很低.AIS患者静脉溶栓前不等待血小板和凝血功能指标可以显著缩短DNT,未观察到其安全性减低.Objective To assess the incidence of thrombocytopenia and abnormal coagulation,door to needle time （DNT）,and safety in patients with ischemic stroke who receive intravenous thrombolytic treatment prior to the availability of blood platelet （PLT） and coagulation results.Methods Consecutive acute ischemic stroke （AIS） or transient ischemic attack patients within 12 hours of symptom onset who were admitted from January 2009 to March 2013 were retrospectively recruited.First laboratory reports in their medical charts were collected to assess the incidence of thrombocytopenia and abnormal coagulation.In the mean time,consecutive AIS patients who received intravenous thrombolysis at Huashan Hospital during the same period were retrospectively recruited.The thrombolytic procedures were further optimized since June 10.3760/cma.j.issn.1006-7876.2014.07.00626,2012.With informed consent,intravenous thrombolysis was initiated without PLT and coagulation results after certain previous history and medications were ruled out.Thrombolytic patients were divided into two groups based on the initiation of thrombolysis before or after PLT and coagulation results.Baseline demographic data,symptomatic intracerebral hemorrhage rates,mortality on the 7th day as well as functional outcome at 3 months were collected.DNT as well as efficacy and safety of thrombolysis therapy were compared between the two groups.Results Of 298 AIS patients within 12 hours of onset,8 had thrombocytopenia or abnormal coagulation.One hundred and twenty cases of intravenous thrombolysis patients were recruited.Waiting for PLT and coagulation results prolonged DNT than without waiting for them （90 min vs 59 min; U =870.000,P 〈0.01）.There was no statistically significant difference in the rate of symptomatic intracerebral hemorrhage （sICH）,early efficacy,7 d mortality and 3-month good outcome between two groups.Conclusions The incidence of thrombocytopenia and abnormal coagulation is low in AIS patients.Initiating intravenous thrombolysis pr

关 键 词：脑缺血 卒中 脑缺血发作 短暂性 血栓溶解疗法 血小板计数 

分 类 号：R743.3[医药卫生—神经病学与精神病学]