急性缺血性中風之治療趨勢

Trend in Treatment of Acute Ischemic Stroke

急性中風應被視為與心臟病發作具有相同急迫性意識之腦發作。對於急性缺血性中風，用重組組識纖維蛋白溶解原活化劑（rt-PA）進行血栓溶解之治療在美國是被認可的方法。經由一大型的隨機、安慰控制組研究證明，雖然有出血徵狀的顯著風險存在，但在輔以rt-PA治療三個月後之結果有顯著的進展。另一血栓溶解藥劑Ancrod，近來亦被應用布急性缺血性中風之治療，目前尚有數種神經保護藥物測試正進行中，並為下一個千禧世紀帶來希望。無論如何，治療的最大潛在障礙在於狹窄的時間限制，若能有長期的經驗證明，或許能使治療之時機有所擴展。大部份中風病人到達醫院時都已太遲，以致不適用於篩選及治療，對於大眾及醫師的教育或許對此盲點有所幫助。

Acute strokes should be conceived as brain attacks, warranting the same sense of urgency as heart attacks. Thrombolytic therapy with recombinant tissue plaminogen activator (rt-PA) is approved in the United States for treatment of acute ischemic stroke. Approval was granted after a large, randomized, placebo-controlled study which showed a significant improvement in 3-month outcomes with rt-PA despite a significant risk factor for symptomatic hemorrhage. Another thrombolytic agent, Ancrod, has recently been applied in treatment of acute ischemic stroke. Trails of several neuroprotective agents are currently underway and carry hope in the new millennium. However, the most substantial treatment barrier is the narrow time window, which may be expanded if long-term experience showed that this is possible. Most stroke patients arrived at the hospital too late to be eligible for screening and treatment. Education of the public and physicians may help to over this difficulty.