PT - JOURNAL ARTICLE AU - Balucani, Clotilde AU - Levine, Steven R. AU - Sanossian, Nerses AU - Starkman, Sidney AU - Liebeskind, David AU - Gornbein, Jeffrey A. AU - Shkirkova, Kristina AU - Stratton, Samuel AU - Eckstein, Marc AU - Hamilton, Scott AU - Conwit, Robin AU - Sharma, Latisha K. AU - Saver, Jeffrey L. TI -急性脑缺血神经系统改善AID - 10.1212/WNL.0000000000201656DP - 2023 07年3月TA -神经学半岛投注体育官网PG - e1038—e1047 VI - 100 IP - 10 4099 - //www.ebmtp.com/content/100/10/e1038.short 4100 - //www.ebmtp.com/content/100/10/e1038.full SO -神经学2023 07年3月;急性脑缺血(ACI)患者神经系统快速改善(RNI)的研究主要集中在医院到达后发生的RNI。然而，随着卒中路径决策和干预越来越多地转移到院前环境，有必要描述ACI合并超早期RNI (U-RNI)患者在院前和术后早期的频率、程度、预测因素和临床结果。方法前瞻性分析院前中风治疗现场管理-镁(FAST-MAG)随机临床试验收集的数据。任何U-RNI被定义为在院前和早期急诊科(ED)到达检查之间的洛杉矶运动量表(LAMS)评分中改善2分或以上，并被分为中度(2 - 3分)或显著(4-5分)改善。结局指标包括良好恢复(改良Rankin评分[mRS] 0-1分)和90天死亡。结果1245例ACI患者平均年龄70.9岁(SD 13.2);45%为女性;院前LAMS中位数为4(四分位范围[IQR] 3-5);最后一次已知井到ED-LAMS的中位数时间为59分钟(IQR 46-80分钟)，院前LAMS到ED-LAMS的中位数时间为33分钟(IQR 28-39分钟)。总体而言，31%发生了任何U-RNI, 23%发生了中度U-RNI, 8%发生了剧烈U-RNI。 Any U-RNI was associated with improved outcomes, including excellent recovery (mRS score 0–1) at 90 days 65.1% (246/378) vs 35.4% (302/852), p < 0.0001; decreased mortality by 90 days 3.7% (14/378) vs 16.4% (140/852), p < 0.0001; decreased symptomatic intracranial hemorrhage 1.6% (6/384) vs 4.6% (40/861), p = 0.0112; and increased likelihood of being discharged home 56.8% (218/384) vs 30.2% (260/861), p < 0.0001.Discussion U-RNI occurs in nearly 1 in 3 ambulance-transported patients with ACI and is associated with excellent recovery and decreased mortality at 90 days. Accounting for U-RNI may be useful for routing decisions and future prehospital interventions.Trial Registration Information clinicaltrials.gov. Unique identifier: NCT00059332.ACI=acute cerebral ischemia; ASPECTS=Alberta Stroke Program Early CT Score; ED=emergency department; IV t-PA=IV tissue plasminogen activator; LAMS=Los Angeles Motor Scale; LKW=last known well; mRS=modified Rankin Scale; NIHSS=NIH Stroke Scale; ROC=receiver operator characteristic curve; SICH=symptomatic intracranial hemorrhage; U-RNI=ultra-early rapid neurologic improvement