【病例学习第2期】Is It Too Late?（是否太迟）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

以下为正文(需要翻译的部分),欢迎会员认领并尽可能在48小时内翻译完毕并提交,将奖励50威望和50金钱.


Is It Too Late?

CV, a 52-year-old woman, presents to the emergency department at a highly regarded stroke treatment facility. The neurologist on call rules out intracerebral hemorrhage and determines that CV is having an ischemic stroke due to an embolus in the middle cerebral artery. He also determines, with the help of CV’s family, that her stroke symptoms began just over 3 hours ago. At present, CV has a National Institutes of Health Stroke Scale (NIHSS) score of 19 of a maximum of 42 (higher score signifies a worse stroke severity). CV’s medical history was significant only for hypertension, which was treated with hydrochlorothiazide 25 mg once daily. The neurologist quickly dials the telephone to request intravenous (IV) recombinant tissue plasminogen activator (rtPA) (or alteplase) from the pharmacy. A pharmacist, new to the hospital setting, answers the call and collects the information regarding CV’s status, but is unsure what to do. The pharmacist recalls learning in school that IV rtPA had to be initiated within the first 3 hours. Should the pharmacist send the IV rtPA?


ANSWER:
Absolutely, and as quickly as possible. Time is brain function! IV rtPA has been approved by the FDA for the treatment of acute ischemic stroke within the first 3 hours of symptom onset. However, based upon the positive results of the European Cooperative Acute Stroke Study (ECASS III), which evaluated the benefits of IV rtPA administered between 3 and 4.5 hours after symptom onset, the American Heart Association Stroke Council has recently expanded their maximum time cut-off for IV rtPA to 4.5 hours (Class Ib recommendation for most patients). ECASS III found that when compared with placebo, patients receiving IV rtPA in the 3- to 4.5-hour window had significantly higher odds (34%) of a more favorable outcome, with no differences in mortality, but a higher incidence of intracranial hemorrhage (P = .001). However, ECASS III did not enroll patients older than 80 years, or those taking oral anticoagulants, with a baseline NIHSS score >25, or with both a history of stroke and diabetes. So, while the 3- to 4.5-hour extended window is still recommended in patients with these characteristics, it carries a weaker recommendation (Class IIb C). Since CV is reporting within 4.5 hours of stroke symptom onset, the pharmacist should send 0.9 mg/kg (maximum of 90 mg) of IV alteplase, with instructions to give the first 10% as a bolus dose and the remainder as a 1-hour infusion.


以下为翻译后的内容感谢“家有儿女”提供，欢迎大家对翻译结果进一步完善。

CV，一位52岁的妇女，到一家很有名气的中风治疗医院急诊就医，提倡把急诊科作为一种非常受重视的中风治疗设施。 神经学家排除大脑内出血并且确定CV有一个由于栓子在大脑中动脉而造成的局部缺血的中风。 他也在CV的家庭帮助下确定，她的中风症状开始于3个多小时前。 当前， CV有全国学院健康中风标度(NIHSS)比分从19多达42 (更高的比分意味着中风更严重)。CV的病史仅高血压是重要的，用氢氯噻嗪治疗每日一次25毫克。 神经学家迅速拨电话给药房请求静脉注射(iv)再组合组织胞浆素原的活化计(rtPA) (或alteplase)。 一名对医院不太了解的药剂师接电话并且收集关于CV’s状态的信息，但是不确定要做什么。 药剂师在学校学习的是IV rtPA必须在前3个小时之内使用。 药剂师应该送IV rtPA ？

答案

尽快的送。 时间是脑功能! IV rtPA由FDA批准在症状起始前3个小时之内作为局部缺血的冲程的治疗。 然而，根据欧洲合作深刻冲程研究的肯定结果(ECASS III)，评估IV rtPA在症状起始后的3到4.5小时之间执行了的好处，美国心脏协会委员会最近扩展了他们的最大期限切除IV rtPA到4.5小时(类对多数患者的Ib推荐)。 ECASS III发现了与安慰剂相比，接受IVrtPA 在3小时到4.5小时窗口有显着更高的可能性(34%)一个更加有利的结果，死亡率没有区别，但是颅内出血的发生率更高(P = .001)。 然而， ECASS III没有包括年龄大于80，口服抗凝剂，与基础线NIHSS比分>25，或者有冲程史和糖尿病的那些患者。 因此，当有3-4.5小时扩展的窗口期的病人，它仍然建议使用(类IIb C)。 因为CV在冲程症状起始4.5小时内报告，药剂师应该送0.9 mg/kg (最大值90毫克) IV alteplase，给予10%作为q起始剂量和剩下的1小时内注入。

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我翻译了半天，原来没有认领，该如何认领啊?水平有限，请多指教！

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>>CV，一位52岁的妇女，提倡把急诊科作为一种非常受重视的中风治疗设施。

第一句就把我看晕了。只好去看原文。兄弟，翻译质量不太行啊。

>>CV，一位52岁的妇女，提倡把急诊科作为一种非常受重视的中风治疗设施。

第一句就把我看晕了。只好去看 ...
屠狗英雄 发表于 2010-2-12  09:43

希望修正下，确实不通顺

CV, a 52-year-old woman, presents to the emergency department at a highly regarded stroke treatment facility
CV，一位52岁的妇女，到一家很有名气的中风治疗医院急诊就医，

recombinant tissue plasminogen activator (rtPA)
重组人组织型纤溶酶原激活剂
这个东西好象一般是写成t-PA的。国内一直都没能力生产。

谢谢指教！