Akut İskemik İnmede İntravenöz Trombolitik Tedavi: Klinik Değerlendirme
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Tarih
2019 Aralık
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: İnme tedavisinde asıl amaç, oklüde vasküler yapının belirli süre içerisinde rekanalizasyonudur. Medikal tedavide rekombinant doku plazminojen aktivatörü (tPA) kullanılmaktadır. Bu çalışmada, tPA tedavisi verilen iskemik inme hastaları değerlendirilmiştir. Gereç ve Yöntem: Temmuz 2015-Ağustos 2017 arasında tPA tedavisi uygulanan 97 akut iskemik inme hastası retrospektif incelendi. Demografik veriler, başvuru semptomları ve tedavi saatleri kaydedildi. Klinik durum ve prognoz ‘National Institutes of Health Stroke Skalası’ (NIHSS) ve fonksiyonel durum ölçeği ile değerlendirildi. Hemorajik dönüşüm bilgisayarlı tomografi ile değerlendirildi. Bulgular: Çalışmaya 61(%62,8) erkek ve 36 (%37,2) kadın hasta alındı. Yaş ortalamaları 60,29±12,62 idi. 7 (%7,2) hastaya 1. saate, 5(%25,8) hastaya 1-2 saat arasında, 31(%32) hastaya 2-3 saat arasında, 34 (%35,1) hastaya 3-4,5 saat arasında tPAbaşlandı. Başvuruda en sık semptom hemi/monoparezi idi (%92,8).%69,1 oranında parsiyel anterior, %16,5 total anterior, %15,8 posterior vasküler oklüzyon saptandı. NIHSS sonuçları 10,39±4,36 (tedavi öncesi) ve 6,63±3,76 (taburculuk) idi. Hastalartam bağımsız (%20,6), kısmi bağımlı (%43,3) ve tam bağımlı (%21,6) olarak taburcu edildi.Hastaların %12’sinde hemorajik dönüşüm izlendi.Platelet değeri düşük olan hastalarda hemorajik transformasyon daha fazlaydı (P<0,05).Hemorajik dönüşüm olan hastalarda mortalite %41,7 idi.Hemorajik dönüşüm gelişimi mortaliteyi artırmaktaydı (p <0,05). Sonuç: İnmede trombolitik tedavi özürlülükte azalma sağlamaktadır. Ancak hemorajik transformasyon mortaliteyi artırmaktadır. Bu da platelet değerindeki düşüklük ile ilişkili olabilir.
Objective: The main purpose of treatment in stroke is recanalization of occluded vascular structure within a certain time period. Recombinant tissue plasminogen activator (tPA) is used for medical treatment. In this study, patients with ischemic stroke treated with tPA were evaluated. Material and Methods: Between July 2015 and August 2017, 97 patients with acute ischemic stroke who were treated with tPA reviewed retrospectively. Demographic data, presentation symptoms and treatment times were recorded. Clinical status and prognosis were evaluated with National Institutes of Health Stroke Scale (NIHSS) and functional status scale. Hemorrhagic transformation was evaluated with computed tomography. Results: 61 (62.8%) male and 36 (37.2%) female patients were included to study. The mean age was 60.29±12.62. tPA was started to 7 (7.2%) patients in 1 hour, 25 (25.8%) patients in 1-2 hours, 31 (32%) patients in 2-3 hours, 34 (35.1%) patients in 3-4.5 hours. The most common symptom was hemi/monoparesis (92.8%). 69.1% partial anterior, 16.5% total anterior and 15.8% posterior vascular occlusion were detected. NIHSS results were 10.39±4.36 (pre-treatment) and 6.63±3.76 (discharged). Patients were discharged with not disabilty (20.6%), partial disabilty (43.3%) and major disabilty (21.6%). Hemorrhagic transformation was detected in 12% of patients. Hemorrhagic transformation was higher in patients with low platelets (P<0.05). The mortality in patients with hemorrhagic transformation was 41%. Hemorrhagic transformation increased mortality (p<0.05). Conclusion: Thrombolytic treatment in stroke decreases disability. However, hemorrhagic transformation increases mortality. This may be related to low platelet value.
Objective: The main purpose of treatment in stroke is recanalization of occluded vascular structure within a certain time period. Recombinant tissue plasminogen activator (tPA) is used for medical treatment. In this study, patients with ischemic stroke treated with tPA were evaluated. Material and Methods: Between July 2015 and August 2017, 97 patients with acute ischemic stroke who were treated with tPA reviewed retrospectively. Demographic data, presentation symptoms and treatment times were recorded. Clinical status and prognosis were evaluated with National Institutes of Health Stroke Scale (NIHSS) and functional status scale. Hemorrhagic transformation was evaluated with computed tomography. Results: 61 (62.8%) male and 36 (37.2%) female patients were included to study. The mean age was 60.29±12.62. tPA was started to 7 (7.2%) patients in 1 hour, 25 (25.8%) patients in 1-2 hours, 31 (32%) patients in 2-3 hours, 34 (35.1%) patients in 3-4.5 hours. The most common symptom was hemi/monoparesis (92.8%). 69.1% partial anterior, 16.5% total anterior and 15.8% posterior vascular occlusion were detected. NIHSS results were 10.39±4.36 (pre-treatment) and 6.63±3.76 (discharged). Patients were discharged with not disabilty (20.6%), partial disabilty (43.3%) and major disabilty (21.6%). Hemorrhagic transformation was detected in 12% of patients. Hemorrhagic transformation was higher in patients with low platelets (P<0.05). The mortality in patients with hemorrhagic transformation was 41%. Hemorrhagic transformation increased mortality (p<0.05). Conclusion: Thrombolytic treatment in stroke decreases disability. However, hemorrhagic transformation increases mortality. This may be related to low platelet value.
Açıklama
Anahtar Kelimeler
İskemik inme, trombolitik, özürlülük, hemorajik transformasyon, Ischemic stroke, thrombolytic, disability, hemorrhagic transformation
Kaynak
Selçuk Genel Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
29
Sayı
4
Künye
Eren, F., Öngün, G., Yıldoğan, A. T., Işık, M., Öztürk, Ş., (2019). Akut İskemik İnmede İntravenöz Trombolitik Tedavi: Klinik Değerlendirme. Selçuk Genel Tıp Dergisi, 29(4), 169-174.
