臨床藥物治療學缺血性腦中風的治療之案例報告 中國醫藥大學藥學系江尚德台大醫院雲林分院藥劑部藥師張有邑 莊謹如 廖玲巧摘要 (recombinant tissue plasminogen activator, rt-pa) rt-pa rt-pa 壹 前言 (7.3 %) (29.0 %) (11.5%) 1 67.9 % 2 (recombinant tissue plasminogen activator, rt-pa) 3 18 80 (National Institute of Health Stroke Scale, NIHSS) 0 42 20 rt-pa 6 25 (modified Rankin Scale, mrs) 0 6 0 2 3 5 6 貳 案例報告 76 175 cm 62.1 kg 2014 10 5 14:50 15:44 36.6 99 20 E1V1M3 179/122 mmhg 66 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015
middle cerebral artery infarct) 16:43 rt-pa 5 mg 1 41 mg (muscle power, MP) 1 3-10 6 (right middle cerebral artery infarct) diltiazem 15 mg TID PO 10 7 X Tazocin (Piperacillin 2 g/tazobactam 0.25 g) 4.5 g Q6H IV 10 8 aspirin 100 mg QD PO esomeprazole 40 mg QD PO Klebsiella pneumoniae Streptococcus agalactiae 10 15 aspirin 100 mg QD PO warfarin 2.5 mg HS PO E1V1M5 E3V4M6 MP 4 10 25 ( ) 表一病人住院期間相關檢查報告 10/5 10/8 10/14 10/20 10/22 RBC (M/ L) 5.09 4.59 4.45 4.98 HB (g/dl) 16.0 14.2 13.4 15.2 HCT (%) 44.3 39.8 38.6 43.1 MCV (fl) 87.0 86.7 86.7 86.5 MCH (pg) 31.4 30.9 30.1 30.5 MCHC (g/dl) 36.1 35.7 34.7 35.3 PLT (K/ L) 173 134 256 290 WBC (K/ L) 10.91 12.83 9.51 7.85 Seg (%) 82.0 76.3 Eos. (%) 0.5 2.8 Baso. (%) 0.2 0.3 NIHSS 25 (right 10/5 10/8 10/14 10/20 10/22 Mono. (%) 7.2 6.2 Lym. (%) 10.1 14.4 T-BIL (mg/dl) 0.47 0.75 AST (U/L) 33 ALT (U/L) 15 12 19 18 BUN (mg/dl) 16 14 CRE (mg/dl) 1.3 0.9 1.0 1.0 Na (mmol/l) 139 134 136 136 K (mmol/l) 3.9 3.5 4.2 4.2 Mg (mmole/l) 0.8 Ammonia N ( mol/l) 20 C-Reactive Protein 10.13 2.88 1.60 PT (sec) 11.1 44.2 36 PTT (sec) 26.0 PT INR 1.03 4.64 3.83 SO2 (%) 95.3 ph 7.396 pco 2 (mmhg) 41.9 po 2 (mmhg) 77.8 HCO 3 (mmol/l) 26.0 BaseExcess (mmol/l) 0.8 參 討論 rt-pa (American Stroke Association Guidelines for the Early Management of Patients With Acute Ischemic Stroke) 4.5 3 rt-pa rt-pa 2 3 4.5 rt-pa 90 Mrs 0-1 ( rt-pa) (52.4% vs. 45.2% OR = 31 2 Jun. 30 2015
臨床藥物治療學表二病人住院期間用藥紀錄 10/5 10/6 10/7 10/8 10/9-10/15 10/16 10/17-10/20 10/21 10/22-10/25 Alteplase 46 mg IF Aspirin 100 mg QD PO Warfarin 2.5 mg HS PO INR > 3 Amiodarone 150 mg IF 150 mg IF Labetalol 25 mg IV Diltiazem 15 mg TID PO 30 mg Q6H PO Atorvastatin 10 mg HS PO Piperacillin/ Tazobactam 4500 mg Q6H IF Cephalexin 250 mg QID PO Pantoprazole 40 mg QD IV Esomeprazole 40 mg QD PO IF ( ) IV ( ) PO ( ) 1.42 95% CI = 1.02-1.76 P = 0.04) 3 3 4.5 rt-pa 2010 4 3 rt-pa 3 4.5 7 (6.2% vs. 5.8% OR = 0.93 95% CI = 0.78-1.12 P = 0.46) 3 (12.3% vs. 12.0% OR = 0.97 95% CI = 0.84-1.13 P = 0.70) (SITS-MOST ECASS III NINDS) SITS-MOST 3 4.5 3 (1.7% vs. 2.2% OR = 1.36 95% CI = 1.01-1.83 P = 0.04) ECASS III (4.8% vs. 5.3% OR = 1.10 95% CI = 0.90-1.33 P = 0.35) NINDS (7.1% vs. 7.4% OR = 1.04 95% CI = 0.88-1.22 P = 0.66) 3 3 4.5 (4.8% vs. 5.3% OR = 1.10 95% CI = 0.90-1.33 P = 0.35) 4.5 rt-pa 2013 5 rt-pa 3 4.5 rt-pa 3 80 NIHSS 25 rt-pa 2014 12 Stroke 6 18 6 rt-pa (3 rt-pa) ( rt-pa) (8.8 % [95% CI,0.8 16.9]; P = 0.0317) 4.5 4.5 rt-pa 18 (+3.2 % [95% CI, 3.9 to 10.4]; P = 0.38) rt-pa 4.5 68 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015
臨床藥物治療 mg/kg 學 E3V4M6 rt-pa 55.89 mg (0.9 mg/ MP 4 kg) 46 mg 肆 結論 0.9 mg/ kg 2010 4.5 rt-pa 7 rt-pa rt-pa 3 (0.90 0.02 mg/kg) 3 (0.72 0.07 mg/kg) rt-pa 70 (3.3% vs. 15.4% P = 0.0257) (5.0% vs. 21.1 % P = 0.0099) mrs 0 2 (53.6%vs. 32.6% P = 0.0311) 70 76 46 mg 0.74 Treatment of Ischemic Stroke: A Case Report Shang-Te Chiang 1, Yu-Yi Chang 2, Jin-Ru Juang 2, Lin-Chu Liao 2 School of Pharmacy of China Medical University 1 Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch 2 Abstract Stroke is one of the major factors contributing to the death of people in Taiwan. It often causes significant changes in patients' body function. The treatment of ischemic stroke has a big influence on stroke prognosis. So far, the major medicine for ischemic stroke 藥學雜誌 123 69 31 2 Jun. 30 2015
臨床藥物治療學參考資料 : is recombinant tissue plasminogen activator (rt-pa). In this case, we discussed about the treatment of ischemic stroke and focused on the therapeutic time of rt-pa. 1. 102 2014 2. 2004; 47: 6 3. Werner Hacke, MarkkuKaste, Erich Bluhmki,et al:thrombolysis with Alteplase 3 to 4.5 Hoursafter Acute Ischemic Stroke.N Engl J Med. 2008;359(13):1317-29 4. Ahmed N, Wahlgren N, Grond M, et. al: Implementation and outcome of thrombolysis with alteplase 3-4.5 h after an acute stroke: an updated analysis from SITS-ISTR. Lancet Neurol 2010;9:866-74. 5. 2013 rt-pa 2013 6. Whiteley WN, Thompson D, Murray G, et.al: Effect of AlteplaseWithin 6 Hours of Acute Ischemic Strokeon All- Cause Mortality (Third International Stroke Trial). Stroke 2014;45:3612-3617. 7. Chao AC1, Hsu HY, Chung CP, et.al: Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients: the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) study. Stroke 2010;41:885-890. 70 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015