Abstract: Objective To analyze the eligibility for recombinant tissue plasminogen activator (r-tPA) in anuniversity hospital.Methods We developed a protocol for hyperacute stroke in an university teaching hospital.Consecutive patients activated the protocol from June 2004 to October 2005 were prospectivelyregistered. The patients were excluded from r-tPA according to the exclusion criteria developedby the Taiwan Stroke Society.Results A total of 182 patients activated the protocol, only 11 (6.04%) received intravenous (IV)r-tPA and 4 (2.20%) received intra-arterial (IA) thrombolysis. The main reasons for exclusionwere minor or improving stroke (46.15%), hypertension (35.16%), insufficient time to completestudies or onset beyond 3 hours after reconfirmation (24.17%) and intracranial hemorrhage(15.93%).Conclusion Only 11 patients received IV r-tPA and 4 patients received IA thrombolysis at ourhospital over a period of 17 months. The results were probably due to the strict exclusion criteriaand new criteria were developed to maximize the eligibility for r-tPA.

Key words: Brain infarction; Plasminogen activators

摘要： 目的 分析重组组织型纤溶酶原激活物（r-tPA）于台湾一医学中心的使用率。方法 针对送到医院的卒中患者我们制定了一套超急性期卒中评估流程。于2004年6月到2005年10月这段期间，入组了182例到院时适用超急性卒中评估流程的患者。依据台湾卒中学会在2003年7月所订立的静脉注射r-tPA准则确定是否给予r-tPA治疗。结果 在182例到院时适用超急性卒中评估流程的病例中，只有11例患者（6.04%）可以接受静脉注射r-tPA，4例（2.2%）可以接受动脉注射r-tPA。患者排除注射r-tPA的原因通常是多重因素的，而其中最主要的排除因素包括：症状过于轻微或自行缓解的卒中（46.15%），血压过高（35.16%），无法在3h内完成整套评估流程或从卒中发生时到再次确认的时间已经超过3h（24.17%），颅内出血（15.93%）。结论 在17个月的入组期间，只有11例患者（6.04%）接受静脉注射r-tPA，4例（2.20%）接受动脉注射r-tPA。整体而言，r-tPA使用率过低，而这跟r-tPA应用准则过于严格可能有关。目前台湾卒中学会已制定新版的r-tPA应用准则，期望能使更多的患者从中受益。

关键词: 脑梗死; 纤溶酶原激活剂