急性缺血性中风（Acute ischemic stroke）通常是因供应脑组织血液的血管内的血栓形成所致，故治疗急性缺血性中风的关键是尽快给患者施以能够溶解血栓的组织型纤溶酶原激活物（Tissue plasminogen activator ，tPA），以溶解阻断脑组织血流供应的血栓，迅速恢复受累脑组织的血液供应，进而加速患者康复。已往的资料分析表明，某些急性缺血性中风的患者如若在发病后及时接受溶血栓治疗，大多数可于发病后的３个月左右基本恢复，甚至是完全康复。

为了确保疗效，急性缺血性中风的患者必须在发病后４小时内获得溶血栓治疗。因此，一旦发病应尽快将患者送到医院接受治疗，而不应该在家等待病情的好转。如何才能够确保急性缺血性中风的患者于发病后４小时内得到溶血栓治疗，满足下列条件是关键：

１、患者必须提高对中风的认识，特别是应该知晓中风的先兆。

２、一旦发病，尽快求助如拨打120，并告知家人。

３、完善急救系统，以便能够尽快将求助的患者接送至各大医院接受溶血栓治疗。

４、专业人员训练有素，急救流程完善，以尽可能缩短患者入院后的检诊时间，而迅速接受溶血栓治疗。

最后，需要指出的是～并非所有急性缺血性中风的患者都具备接受溶血栓治疗的条件，如正在服用抗凝血物，高血压和/或糖尿病患者等就不宜接受溶血栓治疗。

More Stroke Patients Get Clot-Busting Drug But Barriers Remain

Getting people to seek immediate treatment is a major hurdle, experts say

THURSDAY, June 2 (HealthDay News) -- Use of a life-saving clot-busting drug to treat ischemic strokes nearly doubled from 2005 through 2009, but the rates still remain too low, a new study finds.

Acute ischemic stroke occurs when a blood clot cuts off blood supply to the brain. Tissue plasminogen activator (tPA) is the only thrombolytic (clot-dissolving) drug approved to treat this type of stroke in the United States, and it can stave off death and lasting disability, but only if it is administered within 3 to 4.5 hours of stroke onset.

"Overall, tPA treatment rates are improving, but the proportion of ischemic stroke patients receiving the therapy remains very small," said study author Dr. Opeolu Adeoye, an assistant professor of emergency medicine and neurosurgery at the University of Cincinnati in Ohio. "The delayed hospital arrival in the majority of stroke patients is probably the most important factor contributing to low treatment rates."

The findings are published June 2 in the journal Stroke.

In the study, researchers used Medicare records and pharmacy billing codes to see if tPA use had increased in response to measures aimed at improving access to this treatment.

In 2005, 1.1 percent to 1.4 percent of acute ischemic stroke patients received a thrombolytic drug, and 3.4 percent to 3.7 percent received one in 2009.

But after adjusting the numbers to account for billing or coding errors, the researchers found that as many as 5.2 percent -- or about 36,000 of the 700,000 　　　Americans who had an ischemic stroke in 2009 -- received tPA. The study did not track individuals after hospital discharge, so it does not provide any data on how they fared following treatment. The presumption is that the tPA did preserve function and prevent lasting stroke-related disability.

"Increasing public awareness of stroke signs and symptoms, and earlier hospital arrival by stroke patients remain important goals for improving treatment rates further," Adeoye said. "The treatment can only be given in the first few hours after a stroke, but many patients delay seeking care, hoping the symptoms will go away," he noted.

"If someone is suspected of having a stroke, 911 should be called and the person immediately transported to the nearest stroke-ready emergency department," Adeoye explained.

Dr. Irene Katzan, director of the Primary Stroke Center at the Cleveland Clinic in Ohio, said that the new study is great news and confirms what she has seen in her practice. It is gratifying to see that slowly things are moving along, she added.

In stroke care, the mantra is the sooner the better when it comes to tPA use, but a lot has to happen in a very short period of time. Also, some strokes may occur during sleep so the time of onset of symptoms may be unknown, experts have noted.

Stroke symptoms may include sudden numbness or weakness of the face, arm or leg (particularly on one side of the body), trouble speaking or understanding speech, sudden vision problems, sudden trouble walking, dizziness or balance issues, and a severe headache with no other cause.

If someone has a stroke and 911 is called, the ambulance must get them to a stroke center as soon as possible, Katzan said, and there must be processes in place in the hospital to evaluate them rapidly. She said tPA can't be used in bleeding strokes or in individuals taking blood-thinning drugs, with high blood pressure or high blood sugar (glucose) levels. Also, there are state mandates that direct emergency medical services to take patients with acute strokes to the closest stroke center.

"Then the patient would fly through the emergency room, get evaluated with a CAT scan and have blood work within minutes, and if they are a candidate, the intravenous tPA is started," Katzan said.

For this to occur, "everything has to be working correctly," she explained.

When the drug is administered in the right patient, it can work wonders. "Ideally, the person's stroke symptoms are minimal to none three months after the stroke," Katzan said.

Dr. Roger Bonomo, director of stroke care at Lenox Hill Hospital in New York City, said that although there is room for improvement, "it's good news that tPA is being used more."

But obstacles remain. "We need to get people to come to the hospital sooner rather than waiting a while to see if the stroke symptoms get better on their own," he said.

SOURCES: Opeolu Adeoye, M.D., assistant professor, emergency medicine and neurosurgery, University of Cincinnati; Irene Katzan, M.D., director, Primary Stroke Center, Cleveland Clinic; Roger Bonomo, M.D., director, stroke care, Lenox Hill Hospital, New York City; June 2, 2011, Stroke