RT杂志文章SR电子T1神经改善急性脑缺血JF神经学JO神经学FD Lippincott Williams & Wilkins SP e1038 OP e1047 DO 10.1半岛投注体育官网212/WNL.0000000000201656vo100 IS 10 A1 Balucani, Clotilde A1 Levine, Steven R. A1 Sanossian, Nerses A1 Starkman, Sidney A1 Liebeskind, David A1 Gornbein, Jeffrey A. A1 Shkirkova, Kristina A1 Stratton, Samuel A1 Eckstein, Marc A1 Hamilton, Scott A1 Conwit, Robin A1 Sharma, Latisha K. A1 Saver，Jeffrey L. YR 2023 UL http://n.半岛投注体育官网neurology.org/content/100/10/e1038.abstract AB背景和目的急性脑缺血(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