| "급성기 허혈성 뇌졸중의 정맥내 r-tPA 혈전용해치료법
:장기 예후에 대한 초기 신경학적 호전의 의의" |
| 배종석, 유경호 김대훈 황성희 김형철 김성민 마효일 정승철 이병철 |
| 한림대학교 의과대학 신경과학교실 |
| "Intravenous r-tPA Therapy in Acute Ischemic Stroke
: The Implication of Immediate Neurological Improvement
for the Long-term Outcome" |
| Jong-Seok Bae, M.D., Kyung-Ho Yu, M.D., Dae-Hoon Kim, M.D., Sung-Hee Whang, M.D., Hyeong-Chul Kim, M.D., Sung-Min Kim, M.D., Hyeo-Il Ma, M.D., Seung-chul Jung, M.D., Byung-Chul Lee, M.D. |
| Department of Neurology, Hallym University College of Medicine |
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| Abstract |
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"Background : Intravenous recombinant tissue plasminogen activator (r-tPA) infusion is the only established treatment
for acute ischemic stroke so far. We explored whether the demonstrated efficacy of r-tPA could be applied to communi-ty-
based hospitals in Korea and whether the immediate improvements after r-tPA infusion had any predicting value for
long-term outcomes. M e t h o d s : Twenty-six patients (mean age, 69; 46% female) with acute ischemic stroke were treated
with r-tPA, abiding by the National Institute of Neurological Disorders and Stroke (NINDS) protocol. The Neurological
status was measured with the National Institutes of Health Stroke Scale (NIHSS) at baseline, at 1 hour after r-tPA , at 24
hours, and at 7 days and the functional outcome was evaluated with the modified Rankin scale (mRS) and Barthel Index
at 90 days after stroke. R e s u l t s : Of 26 patients, 16 (62%) made full recovery or became independent, 4 (15%) had severe
physical disability, and 6 (23%) patients died. Three patients (11.5%) had intracranial hemorrhage (asymptomatic, 2;
symptomatic, 1). There were no significant differences in age, sex, risk factors, baseline NIHSS scores, hemorrhagic
complication, initial brain CT abnormalities, and onset to needle time between good (full recovery or mRS 0-2) and poor
groups (mRS 3-5 or death) at day 90, except for the improvement of NIHSS examined at 1 hour after r-tPA (repeated
measured ANOVA test, p<0.01). C o n c l u s I o n s : The NINDS r-tPA protocol is feasible in the community-based hospitals
in Korea with the safety and efficacy comparable to the results of NINDS r-tPA trials. In addition, we suggest that the immediate neurological improvement after r-tPA be a predictor for favorable long-term outcomes. J Korean Neurol Assoc 19(4):364~369, 2001 Key Words : Tissue plasminogen activator, Thrombolytic therapy, Treatment outcome, Cerebral infarction" |
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