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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Preclusion of ischemic stroke patients from intravenous tissue plasminogen activator treatment for mild symptoms should not be based on low national institutes of health stroke scale scores
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Preclusion of ischemic stroke patients from intravenous tissue plasminogen activator treatment for mild symptoms should not be based on low national institutes of health stroke scale scores

机译：缺血性中风患者因轻度症状而不能接受静脉内组织纤溶酶原激活剂治疗时，不应基于低的国家健康机构中风量表评分

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Background: Intravenous tissue plasminogen activator (IV tPA) improves neurologic outcome after stroke, but is not recommended for patients with minor neurologic deficits commonly classified by a lower cutoff on the National Institutes of Health Stroke Scale (NIHSS). Because not all stroke signs are captured on the NIHSS, the use of a strict cutoff may exclude functionally impaired stroke patients from IV tPA treatment. Methods: We described functional impairment, safety, and clinical outcome in patients derived from our hospital thrombolysis database who had stroke that was considered disabling despite a neurologic deficit that was considered mild. We used 2 cutoffs: NIHSS score ≤4 and ≤3. Functional impairment was assessed with the modified Rankin Scale (mRS). Results: Between 2008 and 2011, a total of 670 acute ischemic stroke patients received IV tPA in our institution. 107 (16%) of these patients presented with a NIHSS score ≤4; 65 (10%) patients presented with a NIHSS score ≤3. All of these patients were considered functionally impaired (mRS score ≥2). The most frequent symptoms were language impairment (two-thirds), distal (hand) paresis (one-third), and gait disorder in both groups. Symptomatic intracerebral hemorrhage occurred in 1 patient with a NIHSS score of 4 (1%). Despite IV tPA therapy, 26% had a nonfavorable outcome (mRS score 0-1) after 3 months, and 52% had persisting symptoms in both groups. Conclusions: Language impairment, distal (hand) paresis, and gait disorder are common disabling deficits in patients with low NIHSS scores. Judgment of whether a stroke is disabling should not be based on the NIHSS score but on the assessment of the individual neurologic deficits and their impact on functional impairment.
机译：背景：静脉组织纤溶酶原激活物（IV tPA）改善中风后的神经功能，但不推荐用于轻度神经功能缺损的患者，这些患者通常以美国国立卫生研究院卒中量表（NIHSS）的较低分界值进行分类。由于并非所有的中风征兆都在NIHSS上捕获，因此使用严格的临界值可能会将功能受损的中风患者排除在IV tPA治疗之外。方法：我们描述了来自我们医院溶栓数据库的患有功能性损害，安全性和临床结局的患者，这些患者中风尽管被认为是轻度的神经系统缺陷，但仍被认为是致残的。我们使用了两个临界值：NIHSS分数≤4和≤3。使用改良的兰金量表（mRS）评估功能障碍。结果：从2008年到2011年，我们机构共有670名急性缺血性中风患者接受了静脉tPA治疗。这些患者中有107名（16％）的NIHSS得分≤4; 65名（10％）患者的NIHSS得分≤3。所有这些患者均被视为功能障碍（mRS评分≥2）。两组中最常见的症状是语言障碍（三分之二），远端（手）轻瘫（三分之一）和步态障碍。 1例患者发生了症状性脑出血，NIHSS评分为4（1％）。尽管进行了IV tPA治疗，但3个月后仍有26％的患者有不良的预后（mRS评分0-1），两组的症状持续存在52％。结论：低NIHSS评分患者常见的语言障碍，远端（手）麻痹和步态障碍是致残性缺陷。中风是否致残的判断不应基于NIHSS评分，而应基于单个神经功能缺损及其对功能障碍的影响的评估。

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