急性腦中風的靜脈血栓溶解治療

Intravenous Thrombolysis for Acute Ischemic Stroke

腦中風是重要的成人死因，也是造成成人殘障的重要原因，血栓溶解可以恢復腦血流，而使患者獲得完全康復或減輕殘障程度。血栓溶解治療的效果主要取決於治療的時間，經靜脈血栓溶解治療比經動脈血栓溶解治療所耗的時間短，而且比較不需要依賴專家的技術。越來越多的證據支持經靜脈注射組織纖維蛋白溶酶原激酶（tissue-type plasminogen activator, tPA） 可以有效治療急性梗塞性腦中風，現今的治療指引都強烈建議以tPA 血栓溶解來治療中風患者。然而，這項治療卻普遍使用不足。過去一些重要的臨床試驗旨在探討tPA 使用的黃金時間與適當的劑量，藉由回顧這項重要治療的發展，可以更清楚的闡述經靜脈tPA 血栓溶解治療收治的條件與使用原則。

Stroke is a leading cause of death and adult disability. Cerebral blood flow can be restored by thrombolysis that may lead to complete recovery or less severe disability. The benefit of thrombolytic therapy is strongly time-dependent. Intravenous thrombolysis requires less time and expert skill than intra-arterial thrombolysis does. An accumulating body of evidence supports that intravenous thrombolysis with tissue-type plasminogen activator (tPA) is effective for acute ischemic stroke. Current guidelines strongly recommend tPA thrombolytic therapy for stroke patients. However, the treatment is under use. There are several important clinical trials aimed at investigating the appropriate time window and dosage for its effective and safe use. By reviewing the development of this important treatment, the rationale of treatment criteria and protocol can be elucidated more clearly.