Trombólise em pacientes com acidente vascular cerebral isquêmico agudo: aspectos epidemiológicos e funcionais na admissão e alta hospitalar [Digital]
Dissertação
Português
616.831-005.6
Fortaleza, 2012.
INTRODUÇÃO O acidente vascular cerebral isquêmico (AVCI) é causa de incapacidade e morte de pessoas de todas as raças e etnias. Durante o AVCI observa-se redução do fluxo sanguíneo cerebral, que produz uma zona isquêmica com área adjacente de tecido neuronal disfuncional, chamada penumbra,...
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INTRODUÇÃO O acidente vascular cerebral isquêmico (AVCI) é causa de incapacidade e morte de pessoas de todas as raças e etnias. Durante o AVCI observa-se redução do fluxo sanguíneo cerebral, que produz uma zona isquêmica com área adjacente de tecido neuronal disfuncional, chamada penumbra, potencialmente recuperável se administrada a trombólise dentro do tempo de até 4h30min do início do AVCI. Trombólise é a dissolução de um trombo intravascular por meio de medicamento endovenoso, utilizada na fase aguda do AVCI para restaurar o fluxo sanguíneo cerebral. OBJETIVO Avaliar aspectos epidemiológicos, motores e cognitivos de pacientes com AVC agudo, submetidos à trombólise com alteplase® na admissão e alta hospitalar. MÉTODO Observacional, longitudinal, analítico e quantitativo, realizado em Unidade de AVC pública, período janeiro/agosto de 2012. Pacientes trombolisados foram avaliados mediante utilização de escalas neurológias (Glasgow, Mini Mental ? MEEM, Rankin Modificada - ERM e da National Institute of Health Stroke Scale - HIHSS) durante admissão e alta hospitalar. RESULTADOS Nos 38 pacientes a idade variou de 27 a 87 anos; prevaleceram: sexo masculino (60,5%), baixa e média escolaridade (71,1%). Dados clínicos e funcionais: dormência ou fraqueza em hemicorpo (97,4%), dificuldades para andar (97,4%) e falar (92,1%), desvio labial (71,1%), afasia (42,1%). Síndrome da circulação anterior total (39,5%) e acometimento da artéria cerebral média (89,5%). Os que apresentaram afasia tiveram OR=7,8 para óbito. Mortalidade em 24%, destes, 78% tinha 70 anos ou mais. Médias das variáveis de tempo em minutos: janela de tempo (120), porta agulha (75,55), atrasadas em relação aos protocolos validados na literatura, entretanto o tempo porta- imagem (24,45) foi mais rápido se comparado à média do protocolo SITS-MOST. Observaram-se alterações cognitivas (p=0,02) no tempo porta-agulha superior a 90 minutos, associado ao MEEM,. Nas demais variáveis de tempo, não houve associação com as escalas neurológicas. Houve evolução neurológica (NIHSS) significante entre admissão e alta hospitalar (p<0,01), melhora da incapacidade funcional na escala Rankin admissão/alta e após o 90º dia da trombólise (p<0,01). Resultado insignificante no Mini Mental, comparando admissão e alta. O resultado se repetiu na escala de Glasgow. Pacientes foram avaliados pela equipe multidisciplinar: médicos, enfermeiro, fisioterapeutas, fonoaudiólogos e terapeutas ocupacionais. CONCLUSÃO. A trombólise comprovou ser eficaz em melhorar o nível de gravidade neurológica e reduzir incapacidades funcionais de pacientes com AVC isquêmico agudo. O tempo de até 3h58minutos gasto pelos pacientes para chegarem ao hospital a partir do início dos sintomas do AVCI constituiu critério para realização da trombólise. A avaliação pelas escalas NIHSS, Glasgow, MEEM e ERM mostrou-se relevante para reconhecer os défices, influenciando na escolha do tratamento de reabilitação. A assistência integral precoce dada pela equipe multidisciplinar no tratamento clínico e de reabilitação contribuiu para um prognóstico funcional favorável desses pacientes.
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INTRODUCTION: Ischemic stroke is cause of disability and death for people of all races and ethnic groups. During ischemic stroke reduction of cerebral blood flow is observed, which produces ischemic zone with adjacent area of dysfunctional neuronal tissue (penumbra) potentially recoverable with...
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INTRODUCTION: Ischemic stroke is cause of disability and death for people of all races and ethnic groups. During ischemic stroke reduction of cerebral blood flow is observed, which produces ischemic zone with adjacent area of dysfunctional neuronal tissue (penumbra) potentially recoverable with thrombolytic procedure until 4,5hours of beginning of ischemic stroke. Thrombolysis is dissolution of intravascular thrombus with intravenous infusion used in acute ischemic stroke to restore cerebral blood flow.
OBJECTIVE: To evaluate epidemiological aspects, motor and cognitive of patients with acute ischemic stroke who subjected thrombolysis with alterplase® at admission and discharge from the hospital. METHOD: Observational, longitudinal, analytical and quantitative realized in public united of stroke in January/August of 2012. Thrombolized patients were evaluated using neurological scales (Glasgow, Mini Mental ? MEEM, Modified Rankin Scale ? MRS and the National Institute of Health Stroke Scale ? HIHSS) during admission and discharge from the hospital. RESULTS: In 38 patients the age (27-28). Males (60,5%), low and middle education (71,1%). Clinical and functional data: numbness or weakness in hemi body (97,4%), difficult walking (97,4%) and speaking (92,1%) lip deviation (71,1%), aphasia (42,1%).Total anterior circulation syndrome (39,5%) and middle cerebral artery involvement (89,5%). Those patients had aphasia obtained OR=7,8 to death. Mortality (24%) and these, 78% had 70 years old or older. Average of variable in time for minutes: time window (120), needle holder (75,55) were delayed compared to validated protocols in the literature, however the image port (24,45) was the faster than average of protocols SITS-MOST. At time more than 90 minutes the needle holder associated with MEEM, observed changing cognitive (p=0,02). The remaining variables of time there wasn´t association with neurological scales. Evolution in NIHSS scale in admission and discharge (p<0.01). There was improvement in functional disability in Rankin scale admission/discharge and after 90 days of thrombolysis (p<0,01). The Mini Mental result was insignificant comparing admission and discharge. The result was repeated in the Glasgow scale. Patients were evaluated by a multidisciplinary team including doctors, nurses, physiotherapists, speech therapists and occupational therapists. CONCLUSION: The thrombolysis confirmed be effective in improve the neurological severity score and to reduce the functional disability in patients with acute ischemic stroke. The time spent by patients until 3h58 minutes to arrive the hospital from the onset of symptoms of ischemic stroke was the criterion for realizing thrombolysis. The evaluation using NIHSS, Glasgow, MEEM e MRS scales appeared relevant to recognize deficits, influencing rehabilitation treatment. The precocious full time assistance offer by multidisciplinary team contributed to a favorable functional prognosis of these patients. Ver menos
OBJECTIVE: To evaluate epidemiological aspects, motor and cognitive of patients with acute ischemic stroke who subjected thrombolysis with alterplase® at admission and discharge from the hospital. METHOD: Observational, longitudinal, analytical and quantitative realized in public united of stroke in January/August of 2012. Thrombolized patients were evaluated using neurological scales (Glasgow, Mini Mental ? MEEM, Modified Rankin Scale ? MRS and the National Institute of Health Stroke Scale ? HIHSS) during admission and discharge from the hospital. RESULTS: In 38 patients the age (27-28). Males (60,5%), low and middle education (71,1%). Clinical and functional data: numbness or weakness in hemi body (97,4%), difficult walking (97,4%) and speaking (92,1%) lip deviation (71,1%), aphasia (42,1%).Total anterior circulation syndrome (39,5%) and middle cerebral artery involvement (89,5%). Those patients had aphasia obtained OR=7,8 to death. Mortality (24%) and these, 78% had 70 years old or older. Average of variable in time for minutes: time window (120), needle holder (75,55) were delayed compared to validated protocols in the literature, however the image port (24,45) was the faster than average of protocols SITS-MOST. At time more than 90 minutes the needle holder associated with MEEM, observed changing cognitive (p=0,02). The remaining variables of time there wasn´t association with neurological scales. Evolution in NIHSS scale in admission and discharge (p<0.01). There was improvement in functional disability in Rankin scale admission/discharge and after 90 days of thrombolysis (p<0,01). The Mini Mental result was insignificant comparing admission and discharge. The result was repeated in the Glasgow scale. Patients were evaluated by a multidisciplinary team including doctors, nurses, physiotherapists, speech therapists and occupational therapists. CONCLUSION: The thrombolysis confirmed be effective in improve the neurological severity score and to reduce the functional disability in patients with acute ischemic stroke. The time spent by patients until 3h58 minutes to arrive the hospital from the onset of symptoms of ischemic stroke was the criterion for realizing thrombolysis. The evaluation using NIHSS, Glasgow, MEEM e MRS scales appeared relevant to recognize deficits, influencing rehabilitation treatment. The precocious full time assistance offer by multidisciplinary team contributed to a favorable functional prognosis of these patients. Ver menos
Disponibilidade forma física: Existe obra impressa de código : 90191
Saintrain, Maria Vieira de Lima
Orientador
Saintrain, Maria Vieira de Lima
Banca examinadora
Vieira, Anya Pimentel Gomes Fernandes
Banca examinadora
Cavalcante, Tahissa Frota
Banca examinadora
Universidade de Fortaleza. Programa de Pós-Graduação em Saúde Coletiva
Dissertação (mestrado)