Neurology：PHANTOM-S研究显示急性卒中院前溶栓治疗可行

急性缺血性卒中患者静脉用组织型纤溶酶原激活剂（tPA）的获益效应存在很强的时间依赖性。溶栓治疗往往在患者入院后才能进行，如果能够在院前的救护车中完成必要的准备或者进行溶栓处理将可能显着改善预后。德国柏林卒中研究中心的Joachim E. Weber博士等人对此进行了一项研究，研究结果在线发表在2012年12月5日的Neurology杂志上。研究结果显示：救护车中进行院前溶栓是可行的，还没有发现安全性问题。这种新的方法在院前使用tPA，可能有效减少呼叫到给药时间差。其效果正在接受一项前瞻性对照研究的检验。

该研究为卒中院前急性神经治疗和医疗护理优化（PHANTOM-S）研究。研究中研究人员使用特殊的救护车（卒中急救移动单位，STEMO）进行卒中治疗以缩短呼叫到治疗时间差。救护车配一名神经科医师、护理人员及放射科医师，配备CT扫描机、即时实验室和远程放射系统。当特定急诊电话程式提示患者可能为急性卒中时，调度中心就派遣这种救护车。只对能够进行知情同意的患者进行研究特异性操作（即院前溶栓）。研究人员对院前tPA使用的可行性、安全性和操作过程进行了研究。

研究结果显示：从2011年2月8日-4月30日，共有152位患者在STEMO上接受了治疗。获得了77位患者的知情同意。45位（58%）的患者存在急性缺血性卒中，这些患者中有23位（51%）接受了tPA治疗。平均呼叫到给药时间差为62分钟，而2010年治疗的50位连续患者的这个时间平均为98分钟。tPA治疗的患者中有2位（9%）出现了症状性颅内出血，其中1位（4%）死在了医院里。出现的技术故障包括1次CT故障和2次CT图像传输延迟。

该研究所得的数据显示STEMO进行院前卒中救护是可行的。目前还没有发现安全性方面存在问题。这种新的方法在院前使用tPA，可能有效减少呼叫到给药时间差。其效果正在接受一项前瞻性对照研究的检验。

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DOI:10.1212/WNL.0b013e31827b90e5
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Prehospital thrombolysis in acute stroke: Results of the PHANTOM-S pilot study

Weber JE, Ebinger M, Rozanski M, Waldschmidt C, Wendt M, Winter B, Kellner P, Baumann A, Fiebach JB, Villringer K, Kaczmarek S, Endres M, Audebert HJ;for the STEMO-Consortium.

OBJECTIVE:Beneficial effects of IV tissue plasminogen activator (tPA) in acute ischemic stroke are strongly time-dependent. In the Pre-Hospital Acute Neurological Treatment and Optimization of Medical care in Stroke (PHANTOM-S) study, we undertook stroke treatment using a specialized ambulance, the stroke emergency mobile unit (STEMO), to shorten call-to-treatment time. METHODS:The ambulance was staffed with a neurologist, paramedic, and radiographer and equipped with a CT scanner, point-of-care laboratory, and a teleradiology system. It was deployed by the dispatch center whenever a specific emergency call algorithm indicated an acute stroke situation. Study-specific procedures were restricted to patients able to give informed consent. We report feasibility, safety, and duration of procedures regarding prehospital tPA administration. RESULTS:From February 8 to April 30, 2011, 152 subjects were treated in STEMO. Informed consent was given by 77 patients. Forty-five (58%) had an acute ischemic stroke and 23 (51%) of these patients received tPA. The mean call-to-needle time was 62 minutes compared with 98 minutes in 50 consecutive patients treated in 2010. Two (9%) of the tPA-treated patients had a symptomatic intracranial hemorrhage and 1 of these patients (4%) died in hospital. Technical failures encountered were 1 CT dysfunction and 2 delayed CT image transmissions. CONCLUSIONS:The data suggest that prehospital stroke care in STEMO is feasible. No safety concerns have been raised so far. This new approach using prehospital tPA may be effective in reducing call-to-needle times, but this is currently being scrutinized in a prospective controlled study.