BƯỚC ĐẦU ĐÁNH GIÁ HIỆU QUẢ ĐIỀU TRỊ TIÊU SỢI HUYẾT ĐƯỜNG TĨNH MẠCH TRÊN BỆNH NHÂN ĐỘT QUỴ THIẾU MÁU NÃO CẤP TẠI BỆNH VIỆN NGUYỄN TRÃI

Abstract

Background: Stroke is an increasingly common disease with widespread mortality and disability. So far, intravenous thrombolytic therapy remains one of the mainstay and standard treatment methods for acute ischemic stroke (AIS) in the first 4.5 hours. Nguyen Trai Hospital (NTH) has established a Stroke Unit and implemented recombinant human tissue plasminogen activator (rtPA) since November 2020. Objectives: Determining the door-to-needle time in the acute stroke procedure and evaluating the effectiveness of rtPA (IV) treatment in patients with acute ischemic stroke at Nguyen Trai Hospital. Materials and method: Descriptive cross-sectional study. The study subjects were all patients diagnosed with acute ischemic stroke and prescribed rtPA (IV) at the hospital from November 2020 to the end of April 2022. Results: From November 2020 to the end of April 2022, there were 52 cases of acute stroke treated with rtPA (IV) at the hospital. Men accounted for 65.4%. The mean age was 66.2 years old. The mean NIHSS at admission was 10.7 points. 21.2% of cases had large vessel occlusion. The mean door-to-needle time was 64.4 minutes, median 60 minutes. The percentage of patients with good neurological rehabilitation, achieving mRS 0-1 after 3 months was 61.5%. The independent prognostic factors for neurologic recovery after 3 months were: initial NIHSS (OR = 0.819; 95% CI: 0.688-0.975; p = 0.024) and NIHSS reduction after 24 hours ≥ 4 score (OR = 14,204; 95% CI: 1.958-103.054; p = 0.009). The rate of symptomatic cerebral hemorrhage was 5.8%. Mortality rate accounted for 9.6% of the total. Conclusion: Our study showed that rtPA (IV) treatment was effective and safe in patients with acute ischemic stroke in the first 4.5-hour window. The door-to-needle time was still quite long, therefore strategies to optimize the acute stroke procedure are needed to be developed.